The Truth about Pharmacy Benefit Managers

Nobody wants fraud — particularly not in medical care. Accordingly, in 1972, Congress passed the Federal Anti-kickback Statute that outlawed kickbacks for referrals for medical care and other contracts in the medical field. This was to be sure that referrals of patients to other medical care professionals were in the best interest of the patients. In an interesting turn of the law, 25 years ago, the government made exceptions to the Anti-kickback statute, allowing middlemen to negotiate rebates and discounts on medical products. The problem: the middlemen typically are paid by a percentage of the rebate or discount off the list price. The higher the price they negotiate, the higher their piece of the action. ... In today’s show, Dr. Marion Mass explains how the system of pharmacy benefit managers has morphed into a big money-making scheme, and patients are left holding the bag (of higher costs).


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