Big Pharma - Big Ripoffs
Why should an employer focus on prescription cost? Let's follow the money: The U.S. Department of Justice (DOJ) recently announced that a major pharmaceutical company, Novartis Pharmaceuticals, agreed to pay $642 million to settle a lawsuit alleging that Novartis violated the False Claims Act (FCA).
What was the basis for such a massive case? The answer: kickbacks. Novartis allegedly made “kickbacks” both to doctors and patients. The lawsuit alleged that Novartis ran “speaker programs” and other events that were, on the surface, billed as “educational events.” Those events were designed to funnel money, in the form of “honoraria,” to doctors in exchange for the doctors prescribing more of certain drugs sold by Novartis. The doctors also received lavish meals and other benefits from these programs.
Concerning patients, Novartis allegedly used charities to funnel money to patients to cover co-pays when those patients purchased certain Novartis drugs and sought insurance coverage under Medicare or other government-funded healthcare programs. Because Employer Insurance and Medicare would reimburse for the medications at such a high rate, even with those “charitable” donations, Novartis still made huge profits on those drugs.
Employers Foot the Bill
Employers Ultimately Pay the Bill for Big Pharma Fraud
It's not just Novartis, GlaxoSmithKline paid a kickback settlement of $3 billion, Pfizer paid $2.3 billion for kickbacks, Johnson & Johnson paid $2.2 billion in fines for kickbacks, and the list goes on and on and on. Why? How?
Four Pharmacy Benefits Managers control 90% of the market share, 90%. With such a lack of competition and NO TRANSPARANCY, the situation is ripe for fraud at colossal levels.
The government (Medicare and Medicaid), and employers are the ultimate payors for the fraud. Bad actors can steal billions of dollars before the issue is even discovered.
How can we PROACTIVELY prevent fraud? Realignment.
Right now, PBMs benefit from higher prices and higher volume of cost because they are commission based and spread based. Don't fall for the "we will give you a rebate" scheme. It's not a rebate, it's a reduction in commission, and not a large one. Not a reduction the drug cost.
Our Pharmacy Benefit Managers and program is unlike most pharmacy benefit managers in that:
We don’t profit when drug costs increase.
We’re not dependent on rebate revenues.
We don’t benefit from over utilization of drugs.
We don’t answer to profit-focused shareholders.
Smarter Plan Spend
We provide the personal attention, clinical support and customer service you need to properly implement and control your pharmacy program. Our approach to customer service goes beyond the basics. With our tiered service model, you can expect:
Experienced Member Services Representatives – Specifically trained in your company’s benefit plan to provide the most efficient service.
A Client Relations Specialist – Providing one centralized point of contact through which your account will be managed, monitored and measured.
An Account Manager – Who is available to meet as often as quarterly, face-to-face, to evaluate your pharmacy benefit needs to assist in delivering the most cost-effective solutions.
In addition, our Pharmacy Help Desk, located on-site at Pharmacy Benefit Dimension’s headquarters, has experienced staff that is specialized in the various pharmacy benefits offered. The pharmacy help desk staff view the same online, real-time claims on the pharmacy processing system that the retail pharmacists view.