One thing we all hate is the high prices we pay in the US today for our prescriptions. Sure we do get some discounts, but that too has become an effort in algorithmic shopping to click here and click there to get the best price. It shouldn’t have to be that way, but it is as that’s how the systems have been built. There are a ton of discount prescription cards floating around out there and they all vary in one way or another, but the big thing to remember about all of them is that they are a marketing firm that can and will sell your data to make money. In addition, the discount cards act just like a pharmacy benefit manager with getting all your information when you use them to fill a prescription. In addition, some of them offer referral fees so they can increase the size of their data base of patient information. Data means money today and it can be repackaged and resold over and over, and yes, that’s us.
I found a video on YouTube done by a pharmacist that very well in detail describes how the whole process takes place and how these discount cards work. He tells you what to expect and how the pharmacist reacts and uses them for their required input when filling your prescription. He uses some real life examples on a couple commonly prescribed drugs with a brand name and a generic drug. Yes indeed some of this information makes its way to the big pharmacy benefit managers as well.
What is interesting too is that the pharmacist points out with one example, the patient is getting charged the normal “cash” price the pharmacy would have given anyway with an additional $4.00 as a fee added on, so before jumping into any of the discount cards, be sure and ask the pharmacist for the “cash” price first as you may not even need the card at all. It all depends and you have to really check each time. Again the pharmacist makes the point to where they have to send the discount card company information about you so you can get a discount when you use one of them to include the name of your doctor, medication name, etc. so the company now knows who you are, who your doctor is, date of birth, and more. The data is resold to market you for something else, or to compile lists of people taking certain drugs (sold to pharma as an example)
When it comes to privacy policies, you get stuck with the same old legal routine with a policy written by lawyers to be interpreted by lawyers basically that has a lot of “double talk” in the verbiage. This is one big reason I have my campaign and have had it out there for a few years now to get Congress to pass a law to require all data sellers to be licensed-who are they and what are they selling! This really comes in to play when the data about you being sold is flawed and frankly the data sellers don’t care as bad data gets the same price as good data as nobody looks at the data. Why do you think there’s referrals promoting these cards-to get more data to sell!
Again ask the pharmacist for the “cash” discount first as you may not need one of those cards, so find out first. Some pharmacies will refuse to take the cards if the cost of the prescription causes them to lose money as well. I read somewhere that Wal-Mart with their $4.00 generic drug plans being pretty large, no longer will accept the cards. So again using the prescription cards, all comes back around to data for a discount and companies marketing such end up selling or giving the information back to pharma, other marketing companies or even companies like IMS, the largest data seller of health information in the country, making so much money they had an IPO last year and a lot of folks got wealthy from it.
So yes in short, the big pharmacy benefit managers work in one way or another with the big pharmacy benefit managers and can add to the their bases of prescriptions filled using these cards as the card folks sell it to them. I wrote about how pharmacies and insurers are now doing what is called “medication prediction scores” on everyone, and be aware it’s a secret and you cannot get your score, but your insurer can. FICO does this and thinks that everyone should run around with a “score” on medication just like we do with credit, but the big problem is that the data is so flawed everywhere you turn for their prediction scores. It’s a rip on consumers. See what Express Scripts tells you about these scores, and worse yet, they “brag” about these scoring algorithms!
They make their money charging the pharmacy a fee for the referral, and do reserve the right to sell data. It’s crazy that we have to jump through all kinds of hoops anymore with shopping for prescriptions, but that’s what the insurance and pharmacy business had created with their business models and contracts. Here’s another post below on what pharmacists call “clawbacks” with using a pharmacy benefit price with either your PBM or even one of the discount cards. You can end up paying more, so always ask for the “CASH” price first as pharmacy benefit managers are now telling the pharmacists they can’t volunteer this information, you have to ask. The RX Bin number tells the pharmacist who to bill. The discount card folks all have your data to do whatever they please with it as well as the pharmacy benefit managers and transaction records are accumulated.
Here’s another good video done with a taste of humor that explains the role of the Pharmacy Benefit Manager, the middleman cashing in big! It’s done well and the Pharmacy Benefit Manager is jumping all over the counter during the video, getting in the middle.
So in short, we are all getting ripped one way or another and have to “play this game” instead of just a simple process of filling a prescription. The government has their hands in this till as well as now pharmacists are seeing patients with the use of another prescription monitoring program called EQUIPP to see your “star” rating if you are on Medicare as far as medication adherence goes. Yes indeed, before you even show up data has already calculated a score about you that shows how they predict you will be with compliance. It’s a real nasty game, and oh yes, those folks who use cash to pay for prescriptions, well they are now called Outliers as they can’t track enough data on you, so if you like and want privacy, pay cash. Rite-Aid is the latest to announce using the data mining compliance software from EQUIPP.
The flawed prediction scores are indeed a dangerous business as they will end up denying you access at some point as well. “Give old Jane the cheap stuff as our numbers predict she won’t take the expensive meds”…as a simple example.
As a matter of fact, take a look at the first quarter revenue from United Healthcare, as their OptumRX revenue is exceeding that of the revenue produced by their insurance groups, more money made by United Healthcare with their OptumRX pharmacy benefit management company than Medicare Part D policies..the world is changing and they are chasing the money. Within the last few weeks, OptumRX has secured a few large contracts, like CalPers retirement system, Texas employee retirement system, etc. so they do want to control what drugs you can get and when. Don’t forget the clawback video above as they are the pharmacy benefit manager featured in the news report, although they are all doing it.
Look what else gets involved with OptumRX pharmacy benefit management, infusion drugs so they may show up to provide that service for you as well. The link below about OptumRX buying the infusion company has a side listing of a lot of government cronyism in healthcare too if you want to read about it.
There’s a company that’s a subsidiary of United Healthcare, HealthAllies that was created by current CMS Adminsrator Slavit and Elizabeth Warren’s daughter (funded by Soros these days with her think tank) both former McKinsey consultants that will sell you a card to get both care and prescription discounts at the cost of $25.00 a month too. It’s very dirty and corrupt these days in healthcare to say the least.
The discount card business has become very complex with just trying to get a prescription filled today and it’s done with complexities on purpose as everytime we don’t check something, we get fooled and pay more. This is what I call the world of the Attack of the Killer Algorithms as it is math models and computer codes that run everything so be aware, be very aware as it’s a game of being able to click for the right price anymore to the extremes and it shouldn’t be that way. BD
Visit the Medical Quack Blog: http://ducknetweb.blogspot.com/2016/06/the-truth-about-pharmacy-benefit.html