When Elon Musk took to intervened with some difficult truths. Cuban, known for his outspokenness and deep dive into health care reform, gave Musk and other CEOs a crash course in how their decisions directly impact the costs and quality of health care. health in the United States.
“The key is contracts signed by CEOs of self-insured companies,” Cuban wrote in response to Musk’s tweet. He explained that many of these contracts, particularly with Pharmacy Benefit Managers (PBMs), are causing a spiral of costs and poor care.
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Cuban laid out seven major problems with typical PBM deals that affect not only companies like Tesla and Musk’s SpaceX, but also their employees and their families:
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No control over claims data: Companies do not have full access to data on what is being billed or paid.
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Restricted formularies: PBMs control which drugs are covered, often prioritizing profits over health.
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“Specialized medicines” too expensive: they are often increased without justification.
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Rebates come at a cost: The “rebates” paid by drug companies ultimately raise employees’ deductibles and co-pays, hitting the sickest and oldest the hardest.
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Harm independent pharmacies: PBMs often reimburse small pharmacies for less than the price of brand-name drugs, driving many out of business.
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No collaboration with manufacturers: Companies cannot work directly with drug manufacturers to create targeted wellness programs.
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Opaque Contracts: Many PBM agreements include NDAs, which make the system inefficient and increase prices nationwide.
