For medications I take regularly, United Healthcare will only cover medications for a limited time before you have to start getting them from their mail order pharmacy, OptumRx. Wouldn’t be a big deal if Optum could get their shit together long enough to get my meds to me without gaps in my supply.
I’ve had repeated calls with them and even discussions with my HR at work - which it’s fucking ridiculous that I should have to discuss any part of my healthcare with my non-medical-field employer, but that’s a whole rant on its own… I just get fed some bullshit about how using a mandatory Rx provider saves money. Told HR I know our company had ~$20 billion in revenue last year so we aren’t hurting, and I didn’t give two shits about saving money for an insurance company, so they’d need to find a different justification. Basically the only option I had to go with if I wanted to use my own pharmacist (that I can literally see across the street from my bedroom window) and didn’t want gaps in my prescription supplies was to pay out of pocket for my meds, so I guess that’s what I’m stuck with for now.
Thanks for coming to my TED talk. Just needed to vent somewhere.
PS - anyone hiring for Network Operations Techs?
Healthcare in the United States is astronomically expensive and not very good (lots of neglected care and adverse outcomes) for several reasons. But if we eliminated PBMs like OptumRx (PBM = pharmacy benefit manager - think insurance middle-men for pharmacies) then costs would go down a very significant amount overnight. I can’t put an exact figure on it, but it wouldn’t surprise me if it saved everyone 50% or more.
PBMs add no value to the system, they are 100% rent-seekers (or bloodsuckers as OP accurately put it). PBMs add tremendous cost to the system because they wan their “cut” of the action, even though they add nothing of value. They are far worse than passive friction in the system, they are highly active intelligent parasites.
Of course you seldom hear about this stuff because if you want to get away with evil, hide it inside of something large, complicated, and boring. And few things are more large, complicated, and boring than the way a PBM conducts its business. We’re talking fee structures and contracts that make sense to nobody, clawbacks, lack of respect for PHI, all kinds of shenanigans. PBMs simply should not exist.
Instead what do they do? They punch down, of course. They tell you to wear a smartwatch. They tell you to lose weight. They give you an HSA card and act like it’s god’s gift when you’re just spending your own money with a slight tax benefit.
I once wrote a letter to my representative (a Democrat) about how evil PBMs are and how they need to be eliminated. I got a generic “corporations create jobs, tho” type of response. Very disappointing.
Fortunately there are some efforts underway and a champion has emerged, Lina Khan of the FTC. She has launched a probe into the matter and it’s getting some attention. Finally.