Adam Fein published an interesting article today about how GoodRx’s discount card business is allowing PBMs to side-step managed care organizations, avoiding having to pay pass through payments.

In short, consumers can use discount cards, such as GoodRx, to save money on prescription drugs at the pharmacy. When they use GoodRx, they’re benefitting from a PBM’s network rate that they’re not even paying premium for. PBMs whose network rates are utilized through GoodRx are not obligated to pass through the manufacturer rebates to plan sponsors and can keep that money for themselves. It is important to note that 70% of GoodRx’s consumers already have commercial or Medicare Part D insurance, which they’re deciding not to use because GoodRx will save them more money.

Is the value of managed care organizations being questioned?

Reading this reminded me of something that I had read earlier this month by Fast Company. Providers (just like patients in the GoodRx example above) are finding ways to side-step insurers. Concierge practices promise more provider-patient time and more comprehensive health care for an annual membership fee in ADDITION to health insurance. Direct primary care goes a step beyond that by requiring monthly fees and with NO regard to insurance coverage.

Is the value of managed care organizations being questioned?

This is just the beginning. Managed care organizations cannot be completely done away with just yet. Just like colleges and universities can’t be done away with—yet. But changes are happening.

A rip has been made and the seam is ready to be opened.

I’m not rooting for or slamming any single party. I am, however, rooting for whoever is actually in the business of benefiting patients. And there ARE gems among manufacturers, payers, and providers who are honestly showing up for patients.

What’s important is: How will I benefit patients with [[heart failure]] today? What did I do this week to give patients with [[Medicaid coverage]] hope? Why did God give me this position? By the way, those who don’t ask why they have this will have no right to ask why it was taken away.

I need to ask myself these questions, as do you. Irrespective of your level in the food chain.