REMAINING ETHICAL IN AN UNETHICAL CLIMATE
Talk is Cheap
The pharmaceutical industry has an ethics problem, but if you listen to many of the “talking heads” for Big Pharma, they will have you believe that it is the employers, looking for solutions so they can maintain/achieve financial solvency while doing right by their employees, that are being “unethical”.
Under the Insurance Umbrella
In the United States, pharmaceuticals are jammed under the insurance umbrella because most Americans need insurance coverage to help cover the cost of their prescriptions. However, many people paying for health insurance struggle to exist in a state of financial security. It is difficult for many individuals, but it is often even tougher for employers, tasked with carrying coverage for all or many of their employees, some of whom are taking high-cost medications.
Illusive Value
The insurance machine creates dependency on itself by making it seem like we need it to survive. Health insurance advertises itself as a method to protect individuals from health risks and businesses from financial ruin. Armed with the illusion of value and convenience, it leads many people to believe they have a network of support.
The Network is Broken
The sad reality of the situation is that the insurance system/network is broken. Traditional Pharmacy Benefit Managers (PBMs) manage this network and the top seven PBMs have a 96% market share while all the other PBMs fight over the remaining 4%.
These popular PBMs have deals with thousands of pharmacies nationwide and patients can go to them for their needs. Additionally, they answer the phone calls and adjudicate claims, which can give the impression that they have the public’s best interest at heart. However, they also negotiate with the manufacturers. This negotiation is for a floor position on the formulary which is essentially a tiering system of bribery. If you are unfamiliar with the term “formulary”, it refers to a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. It is sometimes referred to as a “drug list”.
Playing the Game
If a drug is in the formulary, then a member can get their drug since someone will pay for it. The PBMs hold all the power and are on board with this set-up as long as the manufacturers continue to pay them. If that ever stops, the manufacturer believes they are out of the game. This is why the manufacturers continue to raise their prices, to satisfy the PBMs appetite for larger rebates and increase profit for shareholders when they can.
While PBMs and drug manufacturers are playing power games with each other, employers and individuals are the ones coming out on the losing end.
Whose Money Is It?
The user of the drug and the payer for the drug have no seat at the table whatsoever. Health insurance networks and carriers can play, but they are not playing with their own money. Whose money is it you might ask? The employer’s. The employer pays the premiums and claims. This is part of why we get the cluster that is the U.S. healthcare system. It is understood that the worse things get from a health perspective, the more profitable it is for Big Pharma.
Stuck in the Cycle
Employers are stuck in the vicious cycle of what the United States healthcare system has become. If you ask yourself, “Why am I using insurance to pay for things that are routine and expected?”, the answer does not make much logical sense. Employers are forced to go outside of the system since they have limited options to escape the cycle.
The Ethical Solution
Employers are forced to make tough decisions, such as to exclude certain drugs from their healthcare plan because they cannot afford the medications and sustain the nonsense. SHARx is the service that employers otherwise would not have to ensure their employees are taken care of.
Employers are making the choice to stop playing the insane game in a nonpainful way. It is about realizing that when health care budgets cannot be predicted or controlled, things suffer. Procurement and enhancing the experience of the member is the answer.
At SHARx, we have a passion to take care of the lost members in the system that was never designed to serve them and who are not being taken care of. We make sure that members get what they need in an affordable way. We strive to allow businesses to be sustainable and have solvency moving forward.
With SHARx, it is possible for employers to do what is right for the people who matter most – their employees.
