Why do drugs like Ozempic cost $1500 in the U.S., but only $147 in Canada? Most people don’t know about the invisible middleman making more than 10 of the top drug companies combined.
Healthcare may seem like a broken system, but it’s actually not broken at all. It works great; it’s just not working for you. Pharmacy benefit managers use their contracts to make massive profits off of everyone.
PBMs may appear to be helpful. They negotiate lower prices for manufacturing companies, reduce out-of-pocket expenses, and handle logistics between employers and insurance companies.
Pharmacy benefit managers charge the employer a very high price and pay the pharmacies a very low price, pocketing the difference. This is known as spread pricing. PBMs decide which drugs your plan covers, how much you’ll pay out of pocket, which pharmacy you can use, and when or if you’ll get your medication.
Cheaper and better drugs are often denied if PBMs don’t get a big enough rebate. They can even force you to fill your prescriptions at specific PBM pharmacies for more profit.
Drug companies have to give PBMs a kickback or “rebate” to get their drugs covered by insurance companies. To afford this rebate, drug companies raise the list price, and PBMs promote the drug that gives them the most profit.
Pharmacy benefit managers own insurance companies and pharmacies. Three of the largest PBMs control 80% of the medications in the U.S. Surprisingly, PBMs don’t exist in other countries.
Dr. Eric Berg DC Bio:
Dr. Berg, age 60, is a chiropractor who specializes in Healthy Ketosis & Intermittent Fasting. He is the author of the best-selling book The Healthy Keto Plan, and is the Director of Dr. Berg Nutritionals. He no longer practices, but focuses on health education through social media.