JustCare

Tag: Mark Cuban

  • Blue Shield of California ends contract with CVS Caremark in attempt to lower drug prices

    Blue Shield of California ends contract with CVS Caremark in attempt to lower drug prices

    FierceHealthcare reports on Blue Shield of California’s decision to end its contract with CVS Caremark in an attempt to lower drug prices for its 4.8 million enrollees. CVS Caremark has been doing all price negotiation and formulary design for Blue Cross of California and pocketing a lot of the rebates and fees it collects from pharmaceutical corporations. Will Blue Shield of California’s enrollees actually see their drug costs drop?

    Going forward, Caremark will only handle specialty drugs for Blue Shield of California enrollees. Amazon Pharmacy, Abarca, Mark Cuban Cost Plus Drugs and Prime Therapeutics will also be involved in different ways in ensuring enrollees have their prescription drug needs met.

    Prime Therapeutics will take on drug price negotiation with the pharmaceutical companies. Abarca will pay pharmacists for people’s drugs. Cost Plus Drugs will develop a simple way of pricing drugs so that people are not surprised when they go to the pharmacy. Amazon will be in charge of drug deliveries and will let enrollees know upfront the cost of drugs.  

    Blue Shield of California says it would like to reduce drug costs by 10 to 15 percent. Given how much money the PBMs currently earn from negotiating drug prices and pocketing rebates and fees for themselves, that should be more than feasible in theory.

    Blue Shield of California says it wants to eliminate drug rebates and fees. But, time will tell if it simply has developed a new prescription drug model that contributes more to its revenues. Blue Shield of California could simply be transferring some profits away from CVS Caremark to itself. 

    The US spent $600 billion a year on prescription drugs in 2021. That’s $1,500 for every individual. Spending continues to rise significantly. Congress has yet to do anything meaningful to lower drug prices other than to give Medicare some negotiating power over a very small number of drugs through the Inflation Reduction Act. So, at this point, any activity that could lower drug prices is a plus.

    Here’s more from Just Care:

  • Don’t rely on Mark Cuban’s Cost Plus Drugs for the lowest prices

    Don’t rely on Mark Cuban’s Cost Plus Drugs for the lowest prices

    I promoted Mark Cuban’s Cost Plus Drugs a while back as a way to get low-cost generics. As it turns out, Darius Tahir reports for Kaiser Health News that Cost Plus Drugs does not always offer the lowest prices. Bottom line, if you have Medicare Part D, you should shop around if you want the lowest prices on your drugs.

    Cost Plus Drugs now offers more than 1,000 prescription drugs. But, it does not manufacture them. So, your local pharmacy could offer the drugs you need at lower prices. You can also check PharmacyChecker.com for low-cost drugs around the world.

    Cost Plus Pharmacy negotiates prices. And, then it is charging you a 15 percent markup from the manufacturer’s price, plus $3.00 for labor for each medicine and then a flat $5 fee to ship as many drugs as you order.

    In a cost comparison of drugs beginning with the letter A, Kaiser Health News (KHN) found Cost Plus Pharmacy did not offer the lowest drug prices for residents of Washington DC most of the time. But, sometimes it offered massive savings. One expensive drug, aprepitant, an anti-nausea medicine, was nearly $1,000 less through Cost Plus Drugs than through GoodRx, $4,815.30 v. $5,740.

    Cost Plus Drugs is really taking out a lot of the PBM (Pharmacy Benefit Manager) and pharmacy markups, since it replaces the PBM as the middleman. Amazon and Walmart are also offering a bunch of low-cost generic drugs.

    Cost Plus Drugs is not a pharmacy but uses Truepill, a mail-order pharmacy.

    Bottom line, you Part D drug coverage should offer you some savings on some drugs, particularly brand-name drugs. But, don’t count on it to give you the lowest out-of-pocket costs. The copays can be higher than the total cost of your drugs through Costco or Cost Plus Drugs, at least for now.

    The good news, if you take a lot of drugs, is that beginning in 2026, you will not pay more than $2,000 in total for your prescription drugs on formulary through your Part D drug plan. That is one of the big benefits of the Inflation Reduction Act passed in 2022.

    Here’s more from Just Care:

  • Does Medicare Part D save you money on generic drugs?

    Does Medicare Part D save you money on generic drugs?

    A new Avalere analysis reveals that more than half of people with Medicare Part D paid the full cost of their generic drugs at least one time in 2020, in some cases as much as they would pay for brand-name drugs. Sarai Radriguez reports for Health Payer Intelligence on the increasing number of people with Medicare Part D who pay the full cost of their generic drugs.

    In the three years between 2017 and 2020, the percent of people with Medicare getting no help from their Part D prescription drug coverage to pay for their generic drugs in at least one instance rose from 45 percent to 63 percent. Their copays were in the same tier as brand-name drugs.

    Drugs for which people paid the full cost included drugs to treat thyroid issues as well as musculoskeletal, cardiotonic, thyroid issues and anxiety. Curiously, a higher percentage of people in low-income subsidy benchmark plans (Extra Help plans) (68 percent) paid the full price of their generics than people in non-benchmark plans (62 percent).

    Medicare Part D plans cannot charge their enrollees more for copays than their negotiated price for a drug. But, they can put generic drugs on high copay tiers, while getting higher discounts for brand-name drugs. So, that’s what they are doing increasingly to maximize their profits. As a result, some brand-name drugs cost enrollees less out of pocket than their generic substitutes during the catastrophic coverage phase of the Part D benefit, even though they cost Medicare more.

    If the skinny version of Build Back Better passes–the reconciliation bill–it would allow federal drug price negotiation for some brand-name drugs without generic substitutes. But, it does nothing to ensure that Part D prescription drug insurers are offering their enrollees coverage at the lowest price possible, for example, at the prices you can get through Mark Cuban’s Cost Plus Pharmacy.

    Here’s more from Just Care:

  • Medicare Part D insurers unwilling to bring down generic drug costs

    Medicare Part D insurers unwilling to bring down generic drug costs

    A new study published in the Annals of Internal Medicine shows that the Medicare Part D insurers would have saved Medicare several billion dollars on generic drugs in 2020 if they paid Mark Cuban’s Cost Plus pharmacy prices. But, had they done so, these insurers would have lost billions in profits. Why is the administration continuing to promote a failed corporate health insurance model, over public health insurance, to the detriment of taxpayers and people with Medicare?

    The whole idea behind having private health insurers “compete” to offer drug coverage is that competition will bring drug prices down. But, the Part D health insurers are not in business to bring down drug prices. They are unwilling to do what Mark Cuban is doing to bring costs down or even to offer their enrollees coverage of their generic drugs through Cuban’s Cost Plus Pharmacy.

    Ed Silverman reports for Stat News that the study finds $3.6 billion in savings to Medicare in one year alone. Of course, that would mean savings to people with Medicare who use these drugs, as well, in the form of lower copays. When the study was done, Cuban’s company produced 100 generic drugs. Now, it produces 700 drugs, suggesting savings would be far greater now.

    The study’s authors say that “The lower prices from [Cuban’s] direct-to-consumer model highlight inefficiencies in the existing generic pharmaceutical distribution and reimbursement system.” What’s more shocking is that it highlights that the Part D private health insurance model for providing drug coverage to people with Medicare will never put taxpayer interests or the interests of people with Medicare first. (Recently, Kaiser Health News exposed that people can’t even count on a given published price of a drug on the Medicare Part D web site. Drug prices can change at any time at the insurers’ whim.)

    The authors say that 64 cents of every dollar spent on generic drugs goes to the producers and distributors, including pharmacy dispensing and shipping. How much of the price goes to the health insurers?

    Meanwhile, many older adults and people with disabilities are cutting their pills in half, delaying filling their prescriptions or dropping their medications altogether because they can’t afford the cost. For thousands each year, an additional $10.40 in copays means stopping filling prescriptions and premature death, according to a recent NBER study.

    For this study, the researchers looked at 77 generic drugs and found that if the insurers had paid Mark Cuban’s Cost Plus prices, they would have cut 37 percent of Medicare’s $9.6 billion in generic drug costs. An additional 12 generic drugs cost the same with Cuban’s pharmacy as Medicare paid.

    Some of the price differences between what the insurers are paying and what Cuban charges are inexplicably huge. Esomeprazole, which is used to treat acid reflux (a generic for Nexium,) cost Medicare about $1.77 a pill. Cuban charges about one tenth the price–$0.19 a pill.

    Here’s more from Just Care:

  • Mark Cuban launches low-cost drug pharmacy

    Mark Cuban launches low-cost drug pharmacy

    The big news this week on the drug pricing front is that Mark Cuban has launched a low-cost generic drug pharmacy. Helaine Olen reports for The Washington Post that Cuban will charge just the cost of manufacturing a generic drug plus 15 percent and a $3 processing fee. Believe it or not, Cuban’s CostPlus Drugs online pharmacy could save some people hundreds, if not thousands, of dollars.

    I wish I could explain how Mark Cuban is selling generic drugs at significantly lower prices than you will ever find at your local pharmacy. But, the great news is that he somehow is. And, he has created a Pharmacy Benefit Manager so that, over time, drugs his company sells should be covered by your insurance. Right now though, your insurance won’t cover drugs you buy from his company.

    Cuban’s prices are so low for some generic drugs, that his online pharmacy can mean the difference between life and death for some people. Even if you have insurance, you might be able to save a fortune relative to what your copay would be with your insurance and get the drugs you need. People who do not have insurance of course also can benefit from Cuban’s drug company. For example, CostPlus Drugs charges $17.10 a month for imatinib, the generic of the cancer drug Gleevec, even though its typical price could easily be more than $2,500 a month.

    Cuban is planning ahead to control drug prices. He is building a prescription drug manufacturing site that will help ensure his generic drugs are as low-cost as possible.

    Today, the federal government reports that more than five million people with Medicare are struggling to afford their drugs, including 1.8 million people with disabilities. CostPlus Drugs cannot begin to help all of them since Part D won’t cover the generic drugs he sells and CostPlus cannot help people needing brand-name drugs. And, that means that many of them will die needlessly.

    In short, Cuban’s effort is a nice opening. But, Congress must step in and regulate all drug prices. Joe Manchin is blocking passage of the Build Back Better Act, which would regulate prices in Medicare for top-selling drugs. Since he does not appear to object to that portion of the bill, we need him to agree to vote for and allow the Democrats to pass at least that portion.

    Here’s more from Just Care: