In this episode, Darshan reacts to how at the start of each year, pharmacists often face the challenge of informing patients that their medications are no longer covered due to formulary changes managed by Pharmacy Benefit Managers (PBMs). PBMs, who work for insurance companies, negotiate drug prices and determine which medications are covered, often based on profitability. Surprisingly, PBMs may prioritize brand-name drugs over generics because of the rebates they receive, which can lead to sudden changes in coverage.

While PBMs claim to help reduce drug costs, they are currently under scrutiny, with the Federal Trade Commission and several state attorneys general investigating their pricing practices and potential anti-competitive behaviors. On the other side, pharmaceutical companies and PBMs often shift blame onto each other, sparking debates about who’s responsible for rising drug prices. Ultimately, clearer communication with doctors about medication costs could improve patient care, though the current system's complexity makes this challenging for both doctors and pharmacists.

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