Every day, millions of Americans are going to the pharmacy to purchase a wide variety of healthcare products. Many of these are prescription drugs, but pharmacy counters also ring up plenty of over the counter medications, dietary supplements, and other health products. Reasons you might take these vary from needing them for your overall health to being confident about your body. Americans, like people in any country, all share the need for pharmaceutical goods. Americans share something else too—the high prices of healthcare products.
Healthcare spending in the U.S. tends to be greater than its outcomes, and this can be for many reasons, though almost all of them share a commonality: high prices. The United States has the highest healthcare spending among developed countries. Drug prices are high, costs of medical services are high, healthcare administration is expensive, and many healthcare workers make higher salaries than in other developed countries. Naturally, these factors aren’t being alleviated by the current COVID-19 pandemic, although everyone has a part to play in helping by following CDC guidelines.
Patients also experience higher prices at the pharmacy, particularly for prescription medication, thanks to healthcare “middlemen.” These are market participants other than the drug manufacturer and the provider or patient. While some of these middlemen theoretically exist to negotiate discounts, it’s alleged that some are actually driving healthcare costs up while making profits for themselves. Here are the most impactful middlemen.
Pharmacy Benefit Managers
Pharmacy Benefit Managers (PBMs) play a significant role in most pharmacy transactions. They basically administer prescription drug plans, meaning they process health insurance claims, determine which drugs are covered, and set prices for pharmacies and customers. On paper, they’re meant to be working out discounts for all involved, but like any company, PBMs exist to turn a profit. By keeping prescription costs competitive, they may actually be ensuring that costs remain high.
The Medicare Payment Advisory Commission has expressed their concerns in the past that many PBMs aren’t choosing the lowest cost drugs and are even charging more than they need to for generic alternatives. Rebate incentives can also be an issue when they increase list prices, and customers don’t benefit when rebate savings are only passed on to insurance companies. It’s difficult to determine how effective PBMs actually are when drug pricing has no transparency.
The other main reason healthcare spending is so high is because of high health insurance premiums, high deductibles, and high copays. Even with the Affordable Care Act, many people in the United States have difficulty affording a good health plan. When you add the fact that some plans, like HMOs or preferred provider organizations, can limit the doctors that customers are allowed to see, their costs can get even higher. People are paying more out-of-pocket expenses than ever, and the rising demand for healthcare services thanks to Medicare and Medicaid aren’t helping. Just as with prescription prices, a lack of transparency with all healthcare costs makes it difficult for customers to shop for the right plan or to even know what they’re paying for when they have a procedure done.
One of the greatest focuses of modern healthcare development is figuring out how to cut out the middlemen, or at least reduce their influence. These are some of the main ways it can be done.
Use a prescription savings card.
As a customer, you won’t be able to directly cut out the healthcare middlemen who influence your prices. That’s up to people like healthcare providers and policymakers. Still, you need all the help you can get to cover your costs, and a prescription savings card is a great way to start.
With this prescription discount card, you can go to most major pharmacists, including Walgreens, CVS, Kroger, and more, and receive up to an 80% discount on prescriptions the next time you go. This isn’t an insurance card, and you can even use it for medications that aren’t normally covered by your insurance. You can also use it if the card’s prices are better than your pharmacists. Simply search for your prescription on the site, select your card or coupon, and start getting discounts. It’s really that easy. You can even use the mobile app to find local pharmacies in your area that take coupons and discount cards.
Find sources beyond your pharmacy.
While this, again, won’t actually change the healthcare system, it can help you avoid paying certain healthcare middlemen. When it comes to OTC medications and supplements, there’s really no need to go to a pharmacist or big box store. Instead, you can often find the best price shopping for such products online. There are even some online stores that offer wholesale prices.
Take this store that offers Kratom products, for example. You can get a Kratom shot for significantly less than the typical price. Kratom, or mitragyna speciosa, is a tropical evergreen, and Kratom leaves can be used for a variety of effects. In low doses, Kratom extract provides a mild stimulant effect. In high doses, it can be used as a painkiller and has properties similar to opiates.
Zen Panda offers three strains of Kratom including Green Maeng Da, Red Maeng Da, and White Maeng Da. Always consult with your doctor for medical advice before ingesting anything.
Look for doctors who provide direct care.
What if you could cut out both the government and insurance companies and instead just deal directly with your doctor? That’s precisely what direct care is. Tip: a primary care physician in Poulsbo, Washington is offering a monthly subscription plan that covers all routine services, including scans. Since healthcare middlemen aren’t taking money from the practice or adding on to their costs, they’re also able to provide non-routine services at wholesale prices.
At the moment, tax incentives don’t exactly encourage employers to switch to direct care methods, but it’s great for individual needs if you don’t get insurance through work. At the moment, you’re only likely to find direct care for primary physicians, but imagine if specialists adopted a similar model as its popularity grew. If you or someone in your family suffered hearing loss, you’d be able to get hearing tests, be treated for conditions like tinnitus, and even be fitted with advanced technology like USA hearing aids, all for a monthly fee.
Offer your own healthcare.
This one is for employers, rather than individuals, but it’s possible to offer your own health insurance plan instead of working through a network. Take employers like Catholic Health Initiatives, for example, who created their own insurance firm back in 2013 to help save on healthcare costs. Many other medical companies have acquired health insurers in order to set their own rules as well.
This kind of practice isn’t just limited to medical companies, either. General Motors partnered with the Henry Ford Health System to provide more affordable health plans to their employees. One of the most effective ways to cut out the middlemen is by simply partnering directly with providers.
Embrace healthcare reform.
Ultimately, it will be practically impossible to cut out healthcare middlemen, or even to significantly reduce their influence, if fundamental changes aren’t made to the healthcare system. Without transparency, it’s impossible to know if middlemen are negotiating prices on the cheapest options or if they’re intentionally choosing more expensive medication to make greater profits. Patients who haven’t met their deductibles yet are typically charged an undiscounted price for their prescriptions regardless. Rebates are also chosen based on how much money PBMs can make from them, instead of being based on the best deal for patients.
We can change the healthcare system and reduce prices, but it will take great effort by individuals, providers, and the government.