Speaker 1: Pharmacists are sworn to secrecy about something you may find
Speaker 1: disconcerting telling you about a cheaper way to pay for
Speaker 1: a drug. Gag clauses and contracts with drug benefit managers
Speaker 1: bar pharmacists from volunteering. The fact that for many cheap
Speaker 1: generic medicines, co pays sometimes are more expensive than patients
Speaker 1: simply paying out of pocket and bypassing insurance. So where
Speaker 1: does the extra money go to? The benefit companies? The
Speaker 1: so called clawbacks may boost profits by hundreds of millions
Speaker 1: of dollars for benefit companies. They've also led to at
Speaker 1: least sixteen lawsuits ince October, joining us as Bloomberg News
Speaker 1: farmer reporter Jared Hopkins who wrote about these contracts, Jared,
Speaker 1: you write that clawbacks can be as little as two
Speaker 1: dollars of prescription or as much as thirty Explain what
Speaker 1: a benefit manager does and how this works. Sure, thanks
Speaker 1: for having me on UM. So benefit managers are obscure
Speaker 1: but influential middlemen UM. Some of the most well known
Speaker 1: ones are Customers might know express Scripts, which is not
Speaker 1: accused in the lawsuits, but there's also Humana and optimr X,
Speaker 1: which are SIGNA also uses optimr x, but what these
Speaker 1: are there, they process prescriptions for insurers and large employers
Speaker 1: that backed their own plans um and they determine which
Speaker 1: drugs get covered by insurance plans um. So they also
Speaker 1: negotiate uh lower drug prices on behalf of those entities,
Speaker 1: and that's what they're designed to do. UM. The flip
Speaker 1: side of that, though, is um they set or they
Speaker 1: help set, what a copay is. And so if you
Speaker 1: go into your drug store and you pay let's say
Speaker 1: twenty dollars UM, it turns out that the cost of
Speaker 1: the drug actually might be fifteen dollars. But and then
Speaker 1: what's happening or according to these lawsuits and according to
Speaker 1: other pharmacists we've spoken to, is that the PBM, the
Speaker 1: pharmacy benefit manager, is clawing back that remaining money, which
Speaker 1: in that case would be say five dollars, and they're
Speaker 1: holding onto that. And so that's what these lawsuits are over,
Speaker 1: which are alleging that that you can't that these PBMs
Speaker 1: can't do this. How is it that none of the
Speaker 1: other insurers who work on this said, Hey, I've got
Speaker 1: a way of making stuff cheaper, and I can get
Speaker 1: companies or people to come and be part of my
Speaker 1: prescription plan by getting rid of the club back. So
Speaker 1: it's a good question. Um, so they're these agreements, These
Speaker 1: contracts that pharmacists have with PBMs generally are restrictive and
Speaker 1: they have these so called gag clauses where pharmacists are
Speaker 1: not allowed to inform their customers about that they can
Speaker 1: potentially get their medication cheaper by paying for cash or
Speaker 1: by going on to another plan or you know, finding
Speaker 1: some sort of sort of alternative way. So now lawsuits
Speaker 1: have been filed against United Health Groups, SIGNA and Humana.
Speaker 1: What are the legal accusations, So there's, uh, yeah, that's
Speaker 1: a good question. There's one is there's racketeering. Is collectively
Speaker 1: we've got racketeering as as an uh an accusation, violation
Speaker 1: of contract, breach of contract, and then also violation of
Speaker 1: the Ariska laws, which are basically laws that govern private
Speaker 1: insurance plans. And so those those kind of what what
Speaker 1: together the lawsuits are accusing of. You know, you think
Speaker 1: of racketeering and you think of the mafia or something
Speaker 1: like that, but in fact, it's really a fraud statute
Speaker 1: that says, you know, if you have organized effort to
Speaker 1: commit fraud, essentially you can end up with the racketeering
Speaker 1: LASSUS and this does feel a bit like it might
Speaker 1: be an organized fraud, doesn't it. Well, there's there's a
Speaker 1: lot of secrecy that goes into UH and that and
Speaker 1: negotiations that involve healthcare negotiations with with UH PBMs. UH,
Speaker 1: there's a rebate that's negotiated with drug companies. But a
Speaker 1: lot of this stuff is is not public and so
Speaker 1: there so we don't really know reading that goes into
Speaker 1: into these sorts of things. Are some states responding to this?
Speaker 1: So a lot of these lawsuits did actually grow out
Speaker 1: of a TV station that had gone an investigation into
Speaker 1: this UH down in New Orleans, and so Louisiana is
Speaker 1: one state in Arkansas that has taken some action UH
Speaker 1: to allow pharmacists to inform their customers that there are
Speaker 1: alternatives to to get drugs a cheaper way, basically UH
Speaker 1: bypassing or trumping UM no no pun attended there UH
Speaker 1: the contracts themselves. But but you should mention that, you know,
Speaker 1: with with everything that's going on with drug pricing, these
Speaker 1: PBMs have been getting a lot more attention lately, in
Speaker 1: particular President Trum talking about UM drug pricing and being
Speaker 1: drug prices being too high. So we may hear a
Speaker 1: lot more about this, This may come out more. Well,
Speaker 1: you know the trade Association for Pharmacy Benefit Managers, Uh,
Speaker 1: you know memo recently was leaked from them expressing concerns
Speaker 1: about what President Trump might uh do in response to
Speaker 1: them and in their role in the drug pricing industry.
Speaker 1: So so it's not just drug makers, Uh, there's other
Speaker 1: entities here that are involved in healthcare and a lot
Speaker 1: of customers, a lot of businesses too, don't aren't familiar
Speaker 1: with pharmacy benefit managers. That's it sounds like a European
Speaker 1: soccer league. It was a revelation to me. I have
Speaker 1: to say your story, Um, that was It was great though,
Speaker 1: and it's on the Bloomberg terminal if you want to
Speaker 1: read it. And thanks so much to Farmer Bloomberg News
Speaker 1: farmer reporter Jared Hopkins for being with us here on
Speaker 1: Bloomberg Law. Coming up, we're going to be talking about
Speaker 1: what's been happening with the investigation into Trump campaign officials
Speaker 1: contact with Russian intelligence agencies. There are more questions every
Speaker 1: day