We’ll come back to pharmacy benefit managers (PBMs) in the next chapters (and a really funny video on PBMs awaits you). For now, though, note that no actual person is supposed to pay a drug’s list price. List prices are explicitly based on PBMs’ need to show greater negotiated discounts for insurers (i.e., the “gross-to-net bubble). So it’s especially criminal when insurers leave a patient on the hook to pay a percentage of coinsurance for a drug that’s based on a list price higher than what the insurer itself will ever pay (and sometimes higher than it costs to make or sell the drug at all).
We contend that drugs represent an incredible benefit to the world and are worth the high prices society pays for them. But it’s important to us — and should be important to society — that individuals who happen to get sick should not be the ones footing the bill for the failures of the system. Drugs are “worth it” to the world on a societal level, and we can and should collectivize these costs through proper insurance for everyone.