The impossible scam of US drug plans

Even the guy who invented them can’t figure them out.

US health insurance is a dismal swamp of scams and opacity, a system whose patient outcomes are in freefall and whose patient costs are screaming upwards on a line that it asymptotic to infinity. As bad as the whole health insurance system is, drug plans are worse.

It is literally impossible to get a good deal on drug plans. Literally. How can I be sure that this is the case? Because Wendell Potter can’t, and if he can’t, you can’t. Potter is the former top Cigna lobbyist who changed sides and became a tireless advocate for Medicare for All, dedicating himself to revealing the evil schemes behind your spiraling costs and declining health.

https://pluralistic.net/2020/03/12/boeing-crashes/#wendellpotter

Potter was one of the architects of the 2003 Medicare Modernization Act (MMA), providing talking points to the Congressmonsters who voted for it. Under MMA, Medicare was prohibited from negotiating drug prices with pharma companies. Thus Americans pay US companies 200–400% more for their meds than Canadians pay to those same US companies:

https://www.gao.gov/products/gao-21-282

Potter is now on Medicare, and so he’s got a front-row seat to the MMA’s effects, two decades on. He’s got an Rx for a Symbicort inhaler for a chronic cough, and he pays $606 every three months for this. That’s because Medicare Part D users are expected to have a drug plan, and these drug plans are all eye-glazingly complex scams:

https://pluralistic.net/2022/05/04/house-always-wins/#are-you-on-drugs

Now, Potter is an industry insider, so he knows that there are often generic alternatives to name-brands like Symbicort. He asked his doc, and she prescribed a generic, fluticasone propionate-salmeterol. That’s where Potter’s tale gets interesting (and for interesting, read “terrible”):

https://wendellpotter.substack.com/p/i-just-caused-a-long-line-at-the

It turns out that, thanks to MMA, Medicare often provides zero coverage for generics, as a condition of secret rebate deals drug plan insurers cut with “Pharmacy Benefit Managers” (PBMs). PBMs are also a scam, one of those…