From another site and perhaps a bit dense for this crowd, but...How little known Pharmacy Benefit Managers, owned by insurers including CVS and UnitedHealth, hurt the U.S. consumer. 
Interesting to note that the U.S. is only country with these PBMs
Five Ways that Big PBMs Hurt U.S. Healthcare–And How We Can Fix It
By Mark Cuban, Co-founder, Mark Cuban Cost Plus Drug Company

Why does my company—the Mark Cuban Cost Plus Drugs Company—exist?

In a drug channel dominated by three large pharmacy benefit managers (PBMs), how can a company launched in January 2022 be such a big part of the U.S. drug pricing conversation?

The answer is simple. The dominant three PBMs put stock price over health. Here are five of their greatest hits:

1. Zero transparency.

The number one rule when contracting with PBMs is that you don’t talk about the PBMs and their contracts. They prevent everyone–providers, manufacturers, employers, and non-affiliated pharmacies—from making public or discussing their pricing terms or any aspect of their contracts. If you do, they’re happy to sue you.
2. Magic names and specialty pharmacies.

The PBMs have decided to take the drugs they can charge the most for and call them “special.” But there’s nothing special about most of these drugs.

Many of these products are small molecule generic drugs. There’s nothing unique about the captive pharmacies they call special and force their customers to buy from. We’ve had patients tell us that they have been charged 100 times more for specialty drugs like Imatinib or Droxidopa than what they or their employers would pay on Cost Plus Drugs.
3. Rebate distortions.

I genuinely believe that CEOs do not understand how their healthcare costs work, particularly as it applies to the rebates they receive from their PBMs. They tend to look at rebates as cash paid by the drug manufacturers. Nothing could be further from the truth.

In reality, rebates are a way that PBMs destroy and distort employer plans at the expense of their employees. That’s because rebates are not paid by the drug manufacturers. They are paid by the company’s sickest and oldest employees.

These rebates could be used to reduce the employee deductibles or to actually pay for the cost of medicines. Instead, the companies keep deductibles higher by forcing sick and older employees to pay more out of pocket, using after-tax dollars.

Because specialty drugs are expensive, employees are likely to reach their deductible caps—while still facing out-of-pocket monthly copays for chronic illness medications.
4. Allowing rebates to determine formularies.

Rebates are also the reason big PBMs restrict the medications they allow to be filled.

PBMS often only reimburse drugs with significant rebates—and exclude drugs from the formulary that don’t have rebates. Why leave out a Humira biosimilar like YUSIMRY that is available on Cost Plus Drugs for a true price of $594, when you can charge an employer more than $8,000 per month for Humira?

Formularies should not exist. Doctors should decide what patients need access to, not the PBMs.
5. S———ing on independent pharmacies.

S———ing is the appropriate word to describe the financial abuse that we’ve heard about from non-captive pharmacies. I couldn’t find a better word.

These pharmacies have zero leverage, so when the PBM says they must pay a direct and indirect remuneration (DIR) fee that is calculated on a whim by the PBM, they must pay the fee. If a PBM decides to audit a pharmacy, it can invent issues, knowing the pharmacy can’t afford to fight.

I just talked to an independent pharmacist facing $200,000 in fines that is going to put them out of business. Another spoke publicly about how they were fined if a patient doesn’t pick up their medications within 30 days.

But it gets worse. These pharmacies buy their brand medications from distributors for a set price. When a patient brings in a prescription covered by Medicare Advantage, traditional Medicare, or an employer plan, the PBM may not fully reimburse the pharmacy for that claim.

The pharmacy, after putting up cash for the inventory and taking sales risk, is expected to lose money on that script. What do you think we’d say about that on Shark Tank? It’s gotten so bad that the smaller pharmacies are transferring brand scripts to the biggest chains—ending long-term patient relationships, risking that patient’s health, and losing front-of-the-house sales.
HOW WE CAN FIX U.S. HEALTHCARE

I can go on and on about the big three PBMs. They are everything that is wrong with this industry.

Here’s the crazy part: There is a fix. The federal government, states, and self-insured employers can stop doing business with the big three PBMs. There is not a single thing that those big three PBMs do that is unique or can’t be replaced by independent rebate-avoiding PBMs. State and federal agencies and big companies could switch out from those big PBMs and use their competitors. This would change an entire industry in less than five years.

Which brings us back to my original question: why is Cost Plus Drugs in business? It’s simple as well.

Everything that I just described has killed the trust that this country has in our healthcare system. Nobody trusts anything beyond their own doctor.

At Cost Plus Drugs, our product is trust. We believe that trust comes with transparency. Our Cost Plus Drugs business model is amazingly simple: We buy drugs and we sell drugs. No rebates, no magic, no complications. We keep our business simple, which allows us to keep our pricing so low.

Here’s how it works. Cost Plus Drugs carries 2,500 drugs. Our goal is to carry every single one that we’re legally able to carry. When you go to Cost Plus Drugs and find the medication that your doctor prescribed, we will show you our actual cost, what we truly pay for it, our markup of 15%, and the pharmacy fill and shipping fee of $10.

If you want to pick up your prescription at a nearby pharmacy, you can choose a pharmacy in our Team Cuban Card network for the same price, plus a fee that goes to the independent pharmacist. All of it is completely transparent for anyone to see at any time. In fact, we will happily send our complete price list to anyone anywhere, so you can see what our prices are.

Try asking that to one of the big three PBMs. The biggest players do everything possible to hide and obfuscate everything they do.

We can bring back trust and transform our system into one that we can once again be proud of. We simply need to introduce transparency—real transparency—and encourage government agencies and self-employed insurers to act in their own self-interest and do what’s best for the wellness of their employees and patients.

Unfortunately, Mark's suggestions are likely to never come to light. As another poster states:

I have so much respect for Mark Cuban taking on this cause, especially given all the choices he could make. Kudos.

So it brings me no joy to point out a few hard lessons I've learned over the last 15 or so years in pursuing similar goals but seeing little progress in the macro trends.

The four biggest lessons are perhaps these:

1) Downside risk. Even if all the things you say about PBMs are true and the HR department, CFO, and CEO agrees with you, you are asking them to fire the following:

- their benefit consultant who is likely in bed with 1 or all 3 big PBMs
- their health insurer who owns the PBM
- the specialty/mail order pharmacy that services many employees
- the ancillary programs offered by PBMs (MTM, adherence, etc)
- a bunch of other companies as partners that help with bells and whistles

Ripping the PBM out means a lot of disruption that could cause impacts to employees, their benefits, and introduce some unknowns by using an alternative.

2) Upside value. What in return does the employer get by switching to a standalone PBM? Save 10-20% on generic medications which represent 2%-3% of overall healthcare spend? This isn't that much. A PBM alternative would need to offer much greater savings across the board (and prove it). This is hard to do because for all their ills, the one concept that most everyone should understand is that scale means purchasing power. Thus the big 3 PBMs can get bigger rebates that smaller PBMs with fewer lives. Even if the PBMs don't pass them through, would you rather have 90% of 100K or 100% of 70K? While I am sure that some PBMs can save money over the Big 3, inevitably many need certain formulary restrictions or certain pharmacy changes in order to make the numbers work.

3) Vertical rules. PBMs were so smart to go vertical and integrate into insurance/pharmacy/provider stacks. It makes it so it's hard to "rip and replace" just the PBM without doing business with the same insurers. The bundled offering means the dollars can move between the two (and offer combined discounts) or that the insurer/benefit consultant doesn't have to play nice with the PBM. Why wouldn't you use the CVS PBM if you're going with Aetna or Evernorth if you're going with Cigna?

4) No leadership in the herd. If employers were serious, why have ALL the cooperative efforts to create alternative insurers/PBMs failed over the last 30 years? Where is the full stack solution of insurer/PBM/consultant that HR departments, CFOs, and CEOs can't wait to talk to? Let's face it: It doesn't exist. Yes, there are some bright spots in certain pieces of the puzzle that exist such as Mark Cuban Drug Co, Costco, and a few others but the full enchilada? No way. Meanwhile the HR department continues to act like Toby Flenderson and resign those contracts (which are below the market average for a company of their size ;).

Boycott Coke & Pepsi? 

The New York Times has an extensive piece that focuses on the state of Maharashtra, in western India, a place that produces enormous amounts of sugar, a product that is an enormous asset to companies like Coca-Cola and PepsiCo:

"The two soft-drink makers have helped turn the state of Maharashtra into a sugar-producing powerhouse. But a New York Times and Fuller Project investigation has found that these brands have also profited from a brutal system of labor that exploits children and leads to the unnecessary sterilization of working-age women.

"Young girls are pushed into illegal child marriages so they can work alongside their husbands cutting and gathering sugar cane. Instead of receiving wages, they work to pay off advances from their employers — an arrangement that requires them to pay a fee for the privilege of missing work, even to see a doctor.

"An extreme yet common consequence of this financial entrapment is hysterectomies. Labor brokers loan money for the surgeries, even to resolve ailments as routine as heavy, painful periods. And the women — most of them uneducated — say they have little choice.

"Hysterectomies keep them working, undistracted by doctor visits or the hardship of menstruating in a field with no access to running water, toilets or shelter.

"Removing a woman’s uterus has lasting consequences, particularly if she is under 40. In addition to the short-term risks of abdominal pain and blood clots, it often brings about early menopause, raising the chance of heart disease, osteoporosis and other ailments.

"But for many sugar laborers, the operation has a particularly grim outcome: Borrowing against future wages plunges them further into debt, ensuring that they return to the fields next season and beyond. Workers’ rights groups and the United Nations labor agency have defined such arrangements as forced labor."

The Times writes that "labor abuse is endemic in Maharashtra, not limited to any particular mill or farm, according to a local government report and interviews with dozens of workers. Maharashtra sugar has been sweetening cans of Coke and Pepsi for more than a decade."

You can read the entire story here.

Why We Let White-Collar Criminals Get Away With Their Crimes

Chris Hedges: How Corporate Tyranny Works

The Golden Age of White Collar Crime

(...) And this clubbiness has human costs. Tax evasion, to pick just one crime concentrated among the wealthy, already siphons up to 10,000 times more money out of the U.S. economy every year than bank robberies. In 2017, researchers estimated that fraud by America’s largest corporations cost Americans up to $360 billion annually between 1996 and 2004. That’s roughly two decades’ worth of street crime every single year. As the links between corporations and regulators become increasingly incestuous, the future will bring more crude-soaked coastlines, price-gouging corporate behemoths and Madoff-style Ponzi schemes. More hurdles to suing companies for poisoning their customers or letting bosses harass their employees. And more uniquely American catastrophes like the opioid crisis and the price of insulin. (...)

Commerce Secretary Wilbur Ross says China’s coronavirus ‘will help’ bring jobs back to U.S.

 Red_Dragon wrote:
 
If you want some details about the example sited in the article....go here...  https://argo-sos.com/wp-content/uploads/2019/05/Argo-Righting-The-Ship-4.30.2019_vFINAL.pdf

Start on page 13.

Off the radar: U.S. CEOs' jet perks add millions to corporate tax bills

 R_P wrote:
 
I get that, but if you could A) provide a safe product and 2) easily prove that your competition's product is unsafe, why wouldn't you? Why doesn't someone bottle clean water and share the results when they test all the competition? 

 ScottFromWyoming wrote:
 
Indeed:

Many consumers buy bottled water on the assumption that it’s safer than what flows out of their tap. That has helped fuel the growth of the bottled water industry, which reached $31 billion in sales in 2018. Forty percent of Americans believe bottled water is safer than tap, a recent CR nationally representative survey found, and about 1 in 6 don’t drink their home tap water.

The issue is that your local bottler might have (had) a similar problem, like the examples given for multiple companies, but you'd never know. You might if it's e. coli (or not, because perhaps instead you thought you ate something bad or whatever), but if it's arsenic or some of the other contaminants mentioned, it's not so easy/much harder.

 R_P wrote:
 

This is a kind of weird thing. There are maybe two reasons why people buy bottled water. 1 is convenience and hey welcome to America. But the only other reason is product safety. If the water bottler in my town left the door open like this company did, there's a small competitor trying to get in, and they'd sweep in pretty easily. It's hard to imagine competition not crushing this company like a bug, long before the FDA grinds into action. In fact, I'd do my own in-store QC and publish the results, knock that co. right out.

The FDA Knew the Bottled Water Was Contaminated. The Public Didn't.

The Best People™
Cushy ambassadorships go to donors, so now a chiropractor is handling the fallout over Greenland

When relations with a traditional U.S. ally hit a rough patch, it is always good to have a capable ambassador on the scene to attempt to smooth things over. One who has extensive experience in dealing with subluxation, for instance, can help get the bilateral relationship realigned in no time.

Wait. What?

Well, if it’s as some chiropractors believe and a subluxated spine is the root of all illness, couldn’t it also perhaps be the key to working out a diplomatic spat? One has to hope, as the let’s-buy-Greenland brouhaha in the United States’ relationship with Denmark is being left to an ambassador whose résumé is devoid of governmental or international experience. She did, however, work as a chiropractor before marrying a now-deceased multimillionaire — and as a soap-opera and B-movie star. Who can ever forget her role in “Deathstalker and the Warriors from Hell”?

Ambassador Carla Sands, whose generous donations to Donald Trump no doubt brought her to the attention of the White House Personnel Office after his election, is not unique in her experience. Her predecessor, appointed by President Barack Obama, had been a Hollywood actor and had his own reality TV show as ambassador. In fact, of the 20 men and women who have served as our ambassador in Copenhagen over the past 60 years, only two of them were career diplomats. The Danes are used to envoys with, to put it diplomatically, interesting backgrounds.

The selling of certain ambassadorships is as much a time-honored tradition entrenched in both political parties as it is thinly veiled corruption. Even Congress’s explicit intervention — a 1974 law saying ambassadorships should go to non-career diplomats only in exceptional circumstances and never with regard to political contributions — didn’t dismantle it. Before the law, noncareer appointees made up about 31 percent of the ambassadorial nominees. After it was enacted, the figure dropped to 30 percent. (...)

Jim Mattis rejoining General Dynamics board of directors

Mussolini’s birthplace cashes in on the surge of far-right tourism

 R_P wrote: 
seems like the sauds are buying weapons from everyone these days

i thought i read where spain and canada are selling to them too

what the hay?

The Trump Administration Is Declaring a Fake Emergency to Sell Weapons to Saudi Arabia

Under the 1976 Arms Export Control Act, the State Department must notify Congress 30 days before concluding an arms sale, which gives Congress the chance to vote on halting the weapons transfer. Under the rarely used provision, however, the president can certify that “an emergency exists” and that an immediate transfer is necessary for “the national security interests of the United States.”

 R_P wrote:

Corporations also are not immune to pressure for change emanating from stockholders and the general public. For example, “ethical investing” is a significant phenomenon with a real bottom-line effect; according to The Wall Street Journal, over the last three years $20 billion flowed into so-called sustainable equity funds in the United States, which invest with a social, political, or environmental purpose in mind—an evident reaction to the 2016 presidential election and its runup. This represents a 25 percent increase from 2014, and inflows in this category significantly outstrip those into traditional mutual funds. Saudi Arabia has been affected by growing pressures to divest from its stock market due to concerns about its behavior, with foreign investors dumping a little more than $1 billion in Saudi stocks in one week of October—among the biggest selloffs since the Kingdom admitted foreign investors in 2015. Improving corporate governance, a growing concern of investors, implicitly encourages the maintenance of a good business reputation, which can be leveraged to take into account human rights concerns in international business dealings.

The private sector has not always acted as a good global citizen. There are certainly many examples where it has not. But corporations are not, in the end, entirely unaccountable. By means of a variety of actions—whether driven by governments, investors, or public opinion—the private sector can be encouraged to do more to support free societies and free peoples.

the huge problem with authoritarian governments is that the people can't say no

they can't or aren't allowed to disagree with authoritarians and their supporters/benefactors

really bad ideas/dogma are postured and violently enforced in the name of the greater good/god

currently you and i can still say no or disagree with our rulers on some stuff

businesses/vendors exposed to markets have to put forth a good product at a fair price or we can say no and move on to someone/products we agree with

regards

How the Private Sector Supports Authoritarians in the Arab World

 siriuss wrote:
 
Sure, but don't forget to fold twice before...