If the PBM is paying for it, then getting a rebate back, it's just means it's essentially a discount on the price. It's the same as a mail-in rebate.
It
can function as essentially a discount. But for whom? The PBM is negotiating
on behalf of the insurer, not out-of-pocket. The PBM negotiates a price that the insurer will pay, then the rebate comes back-- and the PBM passes
some of it back to the insurer, and retains
some of it as profit for themselves. That's how they make much of their money.
You see? A rebate and a discount are accounted differently-- Rebates allow the PBM to profit directly in a way that discounts would not (discounts would rely on the insurer then passing a chunk of the savings
back to the PBM, whereas with a rebate they can just keep a chunk of it).
All the players are broken, that is what I've been saying.
Lol, the chutzpah! You
haven't been saying that at all. You've been endlessly defending the pharmaceutical manufacturers
and the insurers, even while both of those 'players' have been blaming one another-- you've been here arguing they don't profit from inflated prices at all and there's no benefit to reducing the price.
I've been the one saying they're both broken. And now, now that your position has become untenable (as it always does), you're going to forget what you've been arguing for the last several pages.
They don't make money on any of them. They make money from people paying for insurance, that's where all the revenue comes from. If I buy a laptop for $500 and it has a $50 mail-in rebate, I paid $450 for it, I didn't make any money. The reason they dropped Levemir from coverage when the price dropped is because the insurance companies know X amount of people have the condition that requires that drug so they planned their premiums for that. When the drug got cheaper, they don't want the spending for it to go down because they can only make 20% profit on revenue. If revenue goes down, profit goes down; hence, they dropped Levenir for a drug with similar cost that didn't drop in price. Whereas ozempic cost (for weight loss) isn't planned via premiums so they don't wanna cover that because they are then paying for more things than expected and that will eat into their 20% profit margin. Whereas if they adjust the premiums and plan for that added cost, then they will gladly cover it.
This is a very muddled and confused paragraph. When you say "when the drug got cheaper, they don't want the spending for it to go down because they can only make 20% profit on revenue"-- Revenue on
what? You've just told me that
all their revenue comes from insurance premiums. So how exactly would Novo Nordisk charging an insurance company less for Levemir cause revenue from insurance premiums to drop? They can still charge the same premiums. Its only their own expenditure that would drop! Unless you're arguing they want to
maximise their own outgoings?