I appreciate your comments. But, I don’t agree with this one on several fronts.

* I have been in most PBMs and have never seen or heard of anyone paying physicians for switching patients. I have seen patient incentives (e.g., copay waivers). I have seen pharmacist incentives. But, no MD incentives. There have been some times when generic fill rate is tied to a performance scorecard for physicians.

* I think there were some questionable practices in the early days which were in the gray area, but I think post-2002 most PBMs have been fairly clear in how P&T decisions are made and not taking pharma money.

Regardless, I think the key point of your comment is that these need to continue to be arms length relationships and consumers should understand when people have a financial motivation to push them to behavior in a particular way. I agree with that concept.

1. PBMs/insurance companies are paying doctors, 100 dollars a patient, I heard for switching the patient’s branded med to a generic, if one is available. Incentive applies to initiating with a generic as well, deceiving thier own patients in many cases for financial gain, implemented perhaps as a response of the remuneration dispensed to doctors for such a long time. A response to corruption with corruption. If a branded treatment regimen that is effective and tolerable, a doctor should not manipulate thier patients’ health in such a way.

2. I live a few miles away from the Express Scripts headquarters, who last month was fined close to 10 million dollars involving over half of the United States for misleading consumers regarding rebates intended to benefit it’s members and not the execs at express scripts and the company’s bottom line.

As an ex big pharma rep, speaking of PBMs, an unrestricted educational grant size determines in a Pavlovian way what will be preferred on PBMs that, based on information and belief, atrophies the necessary and complete focus on safety, efficacy, and cost of particular medications. Furthermore, the employer providing the prescription benefit to its employees is the ultimate deciding factor regarding co-pays and thier amounts paid by thier employee, which suggest collusion between employers and PBMs.

Did not intend for this comment to be bitter, but informative, so thank you for allowing me to comment.