Direct Contracting with Pharmaceutical Companies
One of the questions we receive frequently is, “Can pharmaceutical entities benefit from direct contracting?” The answer is yes, many of them can. While GM&A can’t partner with every pharmaceutical channel, we can and do provide our direct contracting service to some. The fact is, the rising cost of drugs is getting out of hand and it is becoming increasingly difficult for some insurance companies to offer those drugs at an affordable cost to patients. By negotiating with the pharmaceutical companies, GM&A can help get control over that.
Yes, negotiating. When it comes to big pharma, the thing no one wants to talk about is that there is often a great deal of leeway; generally speaking, the “prices” are not really the prices. Drugs are marked up hundreds of times over – particularly specialty drugs, which now account for 27.7% of total pharmacy spending in America. Perhaps that’s one of the reasons why co-pays greater than $60 have increased by 229% since 2010. *
So, why would they negotiate? While the pharmaceutical companies do have to make a profit, they also have to find price points that work for insurance companies and providers – as these are the means to the end users (also known as patients). And that’s what motivates them to work with negotiators like GM&A.
As stated, we can’t partner with every single pharmaceutical company – although we are actively seeking more to partner with now, and welcome their inquiries. Aside from that, what we can provide on a broader scale is an overall health plan, which includes negotiating for more affordable pharmacy co-pays. We’re living in a medicated age; there is a drug for everything, and that’s an incredible thing. That’s why it’s so important to partner with a health plan
*Source: Independent Health Specialty RX Report