PBM
Psyence Biomedical Ltd. Common Shares
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sounds like how PBM operates, oh wait, they also got themselves into the prescription business, go figure
It's not "no news". I believe the catalyst for the recent stock price collapse was coming from CI earnings, where they said they are basically giving up on a lot of PBM margins to avoid political scrutiny. CVS and UNH tanked too given that have PBMs. Further, earnings were confirmed to be shitty too. Decreases in margins, unclear outlook for 2026, etc. Management said that EPS growth might not resume double digit growth un 2027. I gave up and walked away with a 10% gain.
CI or BMY? CI just warned of margin compression over the next two years due to PBM contract renegotiations and not providing guidance. They tend to operate conservatively so the sell-off is a bit of an overreaction but warranted. Definitely at least a $300 stock if you use the $29.60 EPS and throw a 10 multiple on it. Doesn't seem right to give it any lower of a multiple. BMY is likely a sell the news on the report. Pipeline needs to deliver and it doesn't seem to be doing it.
Pharmacy is about to take a brutal hit from negotiated Medicare pricing and the PBM and insurer worlds are struggling right now too. Feels like forward guidance might be shaky. Still no extension of ACA subsides.
Medicaid is a small part of their business. They have a large Medicare Advantage business and they also own the largest PBM. They should crush the EPS estimate of $2.81 but the key is the MCR and how much they hype their AI pivot.
I posted about SLS forever ago. (Not a penny) but also archer at $9. Posted about HIT at $0.80. Posted about MDAI still moving up. Just actually read the dd and do your own. There are still people posting about real growth potential companies. Someone posted about NUAI @ $0.48 I biught $1000 and sold because I got weak hands but just got to did through the trash and you’ll find the gold. Posted about PFSA before they had a 150% move the day before and got downvoted into oblivion. PBM and CGEN are still sleeper companies.
PBM, BIAF,IMMP, RVPH, SENS after RS will have a look.
$PBM tiny float been trying to go today. 4$ tonight will be 10 soon
PBM - there’s rumors they’ll get breakthrough status. Take that as you will.
You son of a bitch, I'm in. This play is going to print and the DD doesn't fully factor in vibes. The Optum Rx cybersecurity outage was catastrophic for pharmacies. Their PBM wing is on an apology tour "increasing payments to pharmacies" right now, presumably trying to mend fences for their colossal fuckup straining businesses and people to the breaking point before contracts come up for renewal. That client retention groveling will drag profits over the next few quarters, if it even works on everyone. Lastly, open enrollment is finally nigh and I am predicting a decrease in sign ups. Everyone hates UNH. We saw what happened when the CEO got demoted to compost last December, no one gave a fuck. Everyone was already locked in to plans for the year, but they're about to choose again. Some will have options. Some will think of Luigi and say "fuck UNH I'll pay $10/mo more to go with HealthNet." No one is out here saying "I can't wait to sign up for UNH, they're so well known for not fucking over patients!" Situation gets worse for UNH if the ACA subsidies aren't extended and premium cost spikes. Many reasonably healthy people will simply roll the dice on nothing bad happening this year and not sign up for any coverage, leaving only sicker patients who need more care signed up. Lastly, a wild card - Taco dropped a 100% tariff on imported prescription meds. No fucking clue how that is going to play out. Will it be savings due to meds not given? Or losses due to missed meds causing bigger, more expensive problems?
Family member works for an independent pharmacy, this may put them out of business. Pharmacies operate on a very thin margin, and reimbursement rates are set by the PBM. They already lose money on many meds because PBMs set reimbursement rates lower than the medication cost. You can't refuse to fill them or you can get dropped from the contract. Im not convinced the PBMs will change the reimbursement rate enough to cover the cost difference. Basically the cost is now doubling and there is no ability to change how much they get paid. I bought puts on CVS, we will see what happens.
Any of you fine regards have any info on the PBM premarket chaos?
I agree that the PBM threat is understated by bulls. >To me it just seems like the whole US health insurance business is a sinking ship. Lots of people want lower premiums and a public option. If your time horizon is 10+ years, I agree. But the federal government has been pushing seniors more towards Medicare Advantage than the regular Medicare these days because of cost control reasons. I don't see health insurance reform being a thing over the next few years because of how ossified our politics have gotten. PBM legislation is only moving forward because it hasn't been vilified like Medicare for All has been.
I'm bearish. I think it's objectively the worst health insurer in the country and I don't get why anyone would want one of their policies unless they had no other option. Add to that the anti-PBM legislation being proposed, I don't think enough UNH people are considering the threats to their PBM business. All of that is before the DOJ stuff. All we have to get at this point is more reps in office to push for US healthcare reform, which we will since the GOP is torpedoing their chances at every turn, then that will cut into insurer profits. To me it just seems like the whole US health insurance business is a sinking ship. Lots of people want lower premiums and a public option. There are way, way better and lower risk investments than UNH. I don't get the appeal of it.
Momentum and trend support is your main focus. Short terms catalysts are very important as well, they more often than not lead to excessive hype, lot of buys, and might dump before or on the expected catalyst news, aka sell the news. Some notable stocks: Open(being mentioned in reddit million times a day, already up a lot from $0.5), HCTI after RS, PBM a month and half after RS, ICU during sep october 2023, ALZN, CING, MNPR(all those three i picked during may june 2024 and the catalyst ran hard afterward). Forgot to mention, that picking a stock after RS could be a good thing, as the float is tiny(careful from dilution) and the stock moves fast on both ways, that's assuming there is some hyped news on the way...
Fun fact: About a decade ago UNH bought Optum for their prescription solutions PBM. Which ran and as far as I know still runs on Cobol. We were hired as consultants to try and fix it for them. They paid a shit tonne of money and decided Cobol was superior, when the newer .NET solution could only fulfill a few million scripts a day versus the Cobol one who just did unlimited somehow. Whole place runs on the equivalent of Atari's.
Did some major profit on it last year, when it rose from 0.50 to $14. Missed this run, but i'll wait for re-entry. Currently watching SXTP and ALZN and looking for re entry at PBM(did a huge move couple of months after RS due to positive news).
As others have said this one has already did its thing. When you look at CTB ideally you want to see it increase by at least 100%. This type of increase can likely mean an incoming event. SLRX does have a high CTB but it’s trending down from 900 something percent. Also it’s pretty when it’s stable like it this I believe it’s priced into the investment. I’ve seen tickers with very high CTB sit for years…(where my BTCM holders at?) https://preview.redd.it/kxqby904j9hf1.jpeg?width=1179&format=pjpg&auto=webp&s=ecb210d792cec80736f7f6bb65b4188a06e7c5ee For example, PBM has a nice trend up from 137 to 233 over a few days. Sometimes it’s more drastic than that.
GORO for 1. Vanguard and BlackRock increased right before earnings. Almost like institutes know it'll be $1.50 by year end. Yes I'm a shareholder. PBM for 2. 46% institutional ownership. Ibogaine research. If you don't know what Ibogaine is then I most definitely recommend you research it. Get ready to have the most drugged, pill-popping, country on earth all of a sudden have zero desire to use a drug any more, including alcohol. It's not just for addiction, there's positive news for people with brain injuries and PTSD. I'm a shareholder as well.
Thats true but there3 are 2 spots where you could have made 30-40%. I don't gamble on buying in and hoping there is a catalyst $PBM topped at 135%, BTAI, $VERB went to 115 04 15% roughly if you got in pre-market and $BTAI went as high as 70%. All decent gains. I don't claim to have a magic 8ball, ITs 50% skill 50% luck. However i get lucky alot.
$PBM just like the drones were far out and now they’re closing in, this is next. With Joe Rogan, pushing the narrative and Trump loving the approval of the GenX, I’m sure it’s bound to be federally legalized very soon.
You gotta call that the night before , Friday 8/1 .. PBM all the gains took place at market open
Anyone have any news on PBM?
Anyone into PBM? Whats happening with it?
Whats the deal with PBM? Any massive news or something?
As soon as it opens, the PBM is gaining strength
Trump is gonna stick it in and break it off on these crooks. I say that's not enough, PBM system and healthcare systems, taken over by insurance companies needs to be eliminated completely along with the ACA. Eliminate all taxpayer funded insurance carriers. Go to the system we all deserve, expand Medicare to all citizens and not this democrat run money laundering scheme we have now,
$PBM is a low float Psychedelic treatment play that's super cheap, meaning low market cap and stock price.. It's been heavily shorted, yet it's pumping after hours at the moment. I could see the price going down to $2 just as well as it could triple to $12+. Phase 2 trial news is impending, but probably coming out later this year.
Even if it does work, congrats, you will pay less for medication. Guess what will go up as a result? Your insurance premiums. Anyone who believes this BS is an idiot who has never heard 'PBM'. PBMs are the biggest contributing factor to absurd prices. They are why corporate pharmacies have all the power and there's basically no legitimate 'mom and pop shop' pharmacy. UNLESS said pharmacy is operating at a loss or unsustainable profit margins. This is why almost ANYWHERE you see a small pharmacy, you will often see them selling all types or other products, or said pharmacy is also involved in research and development and has created its own product.
It's in the same industry as the rest of the health insurers. Sure it might not rely on government support as much but sell commercial health insurance is far less lucrative and the PBM model might be under attack.
This is pretty surprising. Caremark (the biggest PBM) took Zepbound off their formulary and made Wegovy their preferred GLP-1. Figured it would go the other way.
my brother in autism. they have a profit margin hovering around 1% for the past 15 years. they’re caught with their pants down after losing their PBM. they function primarily in medicaid and to a lesser degree medicare, with everything else being the smallest slice of their pie. Only an absolute moron buys in now.
Eh... PBM should float them for a while
PBM is the best low float primed and ready to fly 🍄🍄🍄
Why is PBM up by 35%? Is this momentum? News incoming? Low float FOMO?
Because I don’t see the health care industry changing anytime soon in the US. These companies are vital to that industry operating no matter how many people dislike them and they will be around for the long haul. If you believe that, like OP of this comment said, it would be a good time to invest in these companies. If you’re worried about government backed programs in the long run, Cigna completely got out of them to focus on commercial/PBM so they could be a safer play (CI has not dropped as much as ELV and UNH though) but I think in the long run the government backed programs will be ok too outside of a little bumpy road in the short term.
I personally have avoided UNH as I believe there will be significant PBM regulations coming. It may be good for trading intermediate term but long term I would be cautious.
they’re in deep, DEEP trouble. they’ve been in mortal peril since they lost their bespoke PBM over medicaid fraud. Conveniently, the CEO who ordered this “monetization” (his words) died riiiight as he could’ve been held accountable.
Genuine question, do you have insurance? You said "main formulary" which makes me think you do, but these copays.... Something isn't right here. Inhalers are typically covered by most plans. I bill dozens of albuterols/ventolins for $0 copay. The Budesonide/Symbicort thing is/has been a thing for a while now. Like you pointed out, could be a formulary thing where the INS just prefers brand (likely due to rebates the PBM negotiated).
Two weeks and two weeks. PBM reform? Also two weeks.
I just read some quick notes on Centene pulling guidance and I honestly have to say, what in the actual f. Do the all these investors think every PBM utilize the same actuaries or population models? Why is there a sector wide sell off?
RiteAid just filed for bankruptcy again after acquiring hundreds of local pharmacies. Walgreens is near bankruptcy and being acquired by private equity to break it into pieces and extract value. Local pharmacies barely exist after massive consolidation. Finally… CVS is not just a pharmacy. It’s the largest pharmacy benefits manager (the only pharmacy with a PBM), and one of the largest health insurers - Aetna. Yes CVS owns Aetna (the only pharmacy with a health insurer). Now, tell me why this is so hard for YOU to understand?
Some specialty pharmacies make $2B in a week or two. That's the dispensing pharmacy. Not the manufacturer. Not the PBM. Not the health plan. Your comment is pants on head stupidity.
Had at $1.1 sold at $2.3 before it backtracked. SVRE gave a very nice benefit too. Waiting for UPC and PBM for a similar move soon.
I would watch it as volume picked and it pumped, but I think it will trace back to at least support level before it might squeeze. PBM, UPC worth looking into, low float and known runners in the past(UPC and PBM ran 30% two days ago already and traced back).
Already moved, what's your PT? SBET did MOASS, SGN did nicely. Waiting for PBM now
I do FP&A for a PBM. Everybody was pricing in GLP-1s being insane blockbusters. They haven’t been. Utilization is much less than expected. For Novo, it doesn’t have a stranglehold on the niche, like Humira in anti inflams did for awhile.
With PBM reform on the way, this is really not a good bet
Only current valuation. The company generates give or take 24 billion free cash flow. This is nearly 9% yield against the current market cap of 265 bil market cap. Basically it means, theoretically, UNH can give out a 9% dividend. That is very high considering that the company with this size and likely secular growth with an aging population. Please note the following: 1. The company will very likely announce buyback due to shares being depressed so much. 2. DOJ is on the losing side in regards to its civil lawsuit against UNH for overbilling because the Special Master judge recommended dismissal of the case. The case may continue but even then DOJ most likely going to settle than go to years of trial. 3. The premiums are going to go up and the reimbursement fees are set to increase for Medicare Advantage in 2026. 4. Tariff proof stock. The scary parts however: 1. No guidance. I have no clue what their adjusted EPS going to be like. 2. PBM. I have no idea how states are going to regulate this in years to come. 3. CEO abrupt absence. I have no idea why there was no gradual transitioning. The relief I get however from these scary parts: 1. Massive stock buying from the insiders especially CEO. 2. CEO's much net worth is in UNH stock. Close to 375 million dollars now. His 60 million stock option likely at around 370. Stocks need to go up for him to get this money. 3. Insurance company can do whatever they like. They will increase the premium or ask the government for more money if people are using it more. They reprice each year. 4. Because of this repricing mechanism. UNH almost always went up from June to Decemeber. Given their new repricing starts the beginning of each year. My conclusion: I personally think everyone should set aside small percentage of their portfolio to health care (remember UNH stock actually went up during tariff fear/recession fear). I rarely recommended it due to valuation. But I do recommend now due to its valuation. And the number 1 health care stock I would recommend is UNH. It is like Exxon if you were picking oil stock. It is like Apple if you were picking tech stock.
lol… bad assumption. My source - go look at SEC filings/profit statements for the insurance industry, pharmaceutical industry, and look at non-profit filings for healthcare systems. You’ll see a common theme very quickly over the last 5 years since COVID…. Insurance, PBM, and pharma are doing either very well or at least decent… hospital systems are getting absolutely killed. The market I’m in, every single hospital system came back in the red in 2023 and all of them will likely report much worse in 2024 when their filings are made public. Budgets are continually getting worse with no changes in Medicare/medicaid reimbursement.
Those MLR requirements are true of their insurance business, but UNH is able to profit at a much higher rate on the provider side of things (Optum) and the PBM side of things (OptumRx). Furthermore, MLR is equal to claims as a % of premium, and ignores other expenses (admin, overhead, etc.) No health insurer profits 20% on their insurance business. I work in this space, that commonly spread chart about UHC’s denial rates is misleading at best. We do not see a reduction in claims or premium with UHC that is commensurate with a denial rate that high. The real way they were (allegedly) gaming the system is on their Medicare Advantage business. They were upcoding claims, forcing their population to appear riskier, and therefore letting them receive more in reimbursements from CMS than they would otherwise be entitled to.
Once upon a Monday, in the smoldering ruins of a red week, a brave Redditor named Mavs-ManiAAC saw the UNH chart bounce and declared: “Healthcare never dies. The pump is real. I’m going full port.” With the precision of a CPA and the recklessness of a YOLO warrior, he slammed every dollar into UnitedHealth. Jim Cramer was probably yelling “BUY” about an unrelated stock, but that didn’t matter. r/wallstreetbets said, “Be a BOL and BTFD” So he did. He was no ordinary investor — he was a Level 99 BOL, deep in the trenches, fueled by Taco Bell and suppressed trauma. ⸻ Wednesday: The Double Tap Bombshell #1: The Nursing Home Allegations The Guardian reports UNH allegedly paid nursing homes to keep patients out of hospitals. Whistleblowers. Congress. Secret deals. The whole nine yards. UNH: “Not true. DOJ passed on it.” Market: “We don’t care.” -5.8% intraday. Portfolio? Torched. Mavs-ManiAAC? Still BOL. Bombshell #2: HSBC drops the kitchen sink HSBC downgraded UNH from Hold to Reduce, slashing the price target from $490 to $270 like it owed them money. “MLR too high.” “PBM risk.” “Return on equity is going limp.” “CEO probably doing a kitchen sink reset.” “Oh and EPS might not recover till 2027, oops lol.” He read it twice. Then threw his phone into the void. ⸻ Thursday: Acceptance (and memes) Mavs-ManiAAC turned to Reddit for guidance. Someone posted a Pepe wearing hospital scrubs crying over a stethoscope. Another user wrote: “UNH is the new GME. Just needs a catalyst… like a miracle.” He DM’d his friend: “Bro I’m literally down 37% but I still think this goes to $600.” ⸻ Friday: The Calm The stock floats around $295. Downgrades continue raining down from Wolfe, TD Cowen, Truist, Bernstein, and Raymond James like Wall Street’s version of Thanos snapping your tendies away. And yet… Mavs-ManiAAC still holds. Because deep down he knows: True BOLs don’t fold. They meme through the pain. They DCA into the darkness. They believe in the comeback. ⸻ He remains… Bagholder. Warrior. Meme Knight of the Round Portfolio. Sir Mavs-ManiAAC, the Boldest of BOLs. “It’s not a loss until I sell. It’s not a loss until the court filings stop. And it’s not over… until UNH hits $600.”
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The insurance business is tough—health insurance, even more so. It’s no surprise that after all these years, Warren Buffett remains a fan of the industry. Just look at the challenges Amazon, Berkshire Hathaway, and JPMorgan Chase faced with their joint venture, Haven (ABC company). They eventually exited the health insurance experiment altogether. UnitedHealth Group ($UNH) stands apart. It’s not just a health insurance company; it’s a comprehensive healthcare giant, unmatched in scale and scope. While the ongoing Medicare investigations and scrutiny of the PBM (Pharmacy Benefit Management) business are not new, these challenges have persisted for years. The recent CEO departure might seem concerning, but it could be a positive development. The company’s strategic architect, Stephen Hemsley, remains on the board, guiding the organization’s trajectory. Under his leadership, UnitedHealth achieved explosive growth. The company’s accountant-led management team is known for its focus on disciplined, sustained growth. The next year may be challenging, especially with limited guidance provided, but UnitedHealth has weathered many storms before. It’s worth remembering how the 2012 Michael Moore documentary cast health insurance companies in a negative light, despite the fact that their profit margins hover around 6%. For instance, UnitedHealth’s $22 billion in net profit on $400 billion in revenue highlights the slim margins in an industry where the true issue lies in the soaring cost of care in America. On Friday, Hemsley bought $25 million worth of UnitedHealth shares at a market price of $288. For context, a million-dollar investment might not raise eyebrows, but $25 million is a significant commitment—even for a healthcare CEO, representing roughly a year’s worth of salary. I’ve decided to go all-in with leaps, confident in the company’s resilience and long-term potential. ⸻ Not a financial advice and opinions are my own. Do your own DD.
Trump and RFK are crushing Pharmacy Benefit Managers (PBMs) per their May 13 press conference. UNH gets 52% of their profit from its in house PBM, Optum. Luigi says it’s going down further.
CVS. Health insurance is under attack. Even the dividend doesn't make it safe if the entire PBM business may become obsolete.
Pass. Insurance is a dogshit business where any pool of capital competes against another pool of capital with limited barriers to entry and a race to the bottom on rates. The customers can’t tell the difference between insurance companies because there isn’t one. The only good thing the company has is the PBM. Everything else is a dogshit competitive business the company bought to hide pbm profits.
Yeah and 30% of their revenue comes from Optum, which is just a PBM middleman. They’re fucked the second that HHS direct to consumer purchase plan is rolled out in less than a month
The EO did not drop UNH, actually that day is was only down a small percentage because their PBM is such a small part of the business
Humira was developed in the UK and Germany. Abbvie Pharmaceutical bought the patent to the drug, they have since been sued multiple times for price gouging and illegally preventing other manufacturers from marketing cheaper identical biosimilars. Not to mention that nations with universal healthcare do not have PBMs making bank of if pricing negotiation. And if we banned prescription drug advertising on TV and other media perhaps they could put those millions of dollars towards research. I have worked on the pharmacy end. Generic drugs that cost literally pennies are charged out to insurers for hundreds of dollars. My husband's metformin wholesales for about $80 for a 90 day supply. Charge to insurance is $750. Who gets a kickback on that, the PBM. Not the pharmacy. It's greed. Just greed.
I think they gonna break UNH up and make them sell off their medical care units and all other non insurance related units including PBM's. Might be a $50 stock in a years time.
We don't care about that article, we're coming for the PBM business.
Usually, what one PBM does, the others do, too. For future reference.
UNH has an annual dividend of $8.40/share. They did not yank their dividend. Most U.S. companies offer UNH as their health plan, and changes to employer-provided health plans typically occur at the end of the year. The WSJ article is weak; if the company is being investigated for Medicaid fraud, the claim is absurd and extremely difficult to prove. Each Medicaid claim goes through multiple channels to prevent fraud. For such fraud to occur, it would have to involve the patient/doctor, UNH, drug companies or third-party data providers, and Medicaid. UNH has been investing heavily in AI, and its business model, particularly through Optum's PBM operation-stands to benefit tremendously, as these services are primarily driven by relational data management and brokerage. I own UNH and find this hit on my investment as stupid.
Oh grants. Thanks for the enlightenment. That means “free money“. U have absolutely no clue. PBM’s are propaganda? Do yourself a favor and google how much PBM’s increase the cost of drugs.
Pharma worker here (scientist): Because it’s a) unenforceable and b) pharmas don’t “set” prices. What you pay is an agreement between your insurance, a PBM, and the pharma. PBMs have much more of an influence over what you end up paying than pharmas do. Rather than having a centralized government agency that negotiates coverage and deals for how much insurers will cover the drug and at what price, it’s outsourced to PBMs.
FYI 35% of UNH's revenue comes from it's PBM (OptumRx), 3rd biggest in US
If you’re playing it safe, wait for a verdict on PBM. If you’re willing to risk it, now.
1.) They literally said their revenue will shit the bed because of unexpected dynamics in the field and they cannot give guidance. Sure they have historically had a nice chunk of cash on hand, but last years revenue will not equate to this years. That is also excluding all the suits going on with the company. That is why their price dropped. There is no guidance to factor in pricing. 2.) See above. 3.) Maybe. But also need to factor in a huge part of their business recently was targeted with an EO a few weeks ago (Optum) surrounding transparency of PBM’s. How that technically plays out is up in the air. But even at a state level there is a lot of legislative pressure to keep them at bay. That will absolutely not help out their company if you are looking at it from a profitability standpoint. Ethically that is a whole different argument in which some of the most conservative states are not even siding with UNH on. 4.) While UNH has a global footprint, the systems pulling in the most money are not modeled after the US model of care. I don’t see this as bullish in anyway. 5.) I see it as more likely to lead to efficiencies and access, the latter of which UNH has publicly stated is causing their revenue to decline. This comment also tells me you don’t understand the main drivers of what makes their main market unhealthy (US). AI is not going to magically fix that.
The real issue is PBMs A PBM is like a mafia don who: Controls the docks, ships, and warehouses (they own pharmacies, insurers, even clinics/ health systems) Riggs the auctions (they steer you toward their own drugs and pharmacies) Takes secret kickbacks (rebates from drugmakers they don’t pass on) Tolls every shipment (opaque spread-pricing skims the difference between what they bill and what they pay) Silences competition (excludes lower-cost pharmacies or drugs) What those tricks mean in plain terms Secret kickbacks (rebates): Drug companies give PBMs discounts they never share with you, so your out-of-pocket stays high. List-price inflation: They let manufacturers jack up sticker prices so their “discounts” look big—even though you still pay more overall. Opaque spread-pricing: They tell your insurer, “We paid $100 for this drug,” tell the pharmacy, “We’ll pay you $80,” and pocket the $20 gap—without ever showing you the math. Network lock-in: They push you into their own or favored pharmacies, shutting out cheaper options. You end up paying more at every turn, while the PBM pockets the extra.
I have a completely different take. The US pays the entire load of the R&D costs for drugs and the rest of the World does not. The drug cos completely deserve to recoup their R&D costs, but not to be paid for by one Country. This administration will end PBM's (huge expense) and it is not unreasonable to have stabilized prices throughout the World and give more affordable access to people they may not have insurance.
It’s still another 30% overvalued if PBM become illegal.
UNH PBM accounts for 50% of profits. Even if the PBM side gets completely eliminated the stock is already halved in price.
It does when you realize Aetna is owned by a PBM (CVS caremark) that gets rebates (kickbacks) from drug companies for putting their thing on the formulary over a competitor. And sets their own reimbursement rate to profit more vs the reimbursement rate for other pharmacies forcing a loss.
Potentially lower Rx costs should be seen as bullish for UNH, even if they have some risk owning a PBM
PBM's originated under ObamaCare and only made the problem worse.
It’s not big pharma it’s the PBM’s that need dismantled
I know nobody wants to actually research companies before buying them, but if UNH loses their PBM unit because of Trump’s EO, they’ll lose half of their profit.
And this is why they want everyone uneducated about civic activity and legislative movement. Anyone who knows a modicum of how the govt works knows not only will this EO be ineffective, the same people in power already put things in place to prevent it from happening 😭 Republicans cry and whine when Bernie Sanders introduces the concept of low-cost drugs through govt-PBM negotiations, much like how Medicare does. It would have had an actually effective result. Guess who voted it down?
Any word on Big Insurance or Big PBM?
The Pharmacy Benefit Managers (PBM's) are the problem. They collectively made $573 billion in 2024. Their brokers, who are a fiduciary to the PBMs and not employers, take an 8% to 12% spread on top of that. So, roughly $625 billion in 3rd party profiteering on our pharma spend. PBM's: United Health, Aetna, Carrmark, Optum, Expree Scripts, Prime. Brokers: Marsh McClellan, AON, Gallagher, Willis, WTW etc.
Look at PBM stock next. Die your DD
Wait until people figure out PBM’s are who fucks the drug prices up and then how much money UNH makes from their pbm, OptumRx. For the sake of humanity, I hope this position goes to zero.
The PBM’s are the piece of the puzzle that I think most aren’t aware of. They are the mafia style middlemen racketeers that hover up all the money. If there was one group that needs abolished, it is them.
PBMs absolutely extort rebates from manufacturers in exchange for access/exclusive access to the PBM formulary.
You clearly don’t know what the fuck you’re talking about when it comes to how the pharma industry actually works. Stop acting like drug companies are these fragile little babies who are gonna wither away if they don’t get to price-gouge insulin and cancer drugs at 1000% markups. They already make obscene profits even with price regulations in most developed countries. Europe, Japan, Canada… they all pay a fraction of what Americans pay, yet somehow their pharma industries haven’t collapsed. You know why? Because the margins are still fat as hell. And don’t pull the “rare diseases” sob story out of your ass. The vast majority of PBM and drug pricing battles are over blockbuster drugs, not orphan drugs. Most rare disease drugs are protected by government incentives, patent extensions, and exclusivity deals. The U.S. government literally hands these companies free money and market monopolies under the Orphan Drug Act. They’re not developing this stuff out of charity. They do it because Uncle Sam guarantees they get paid. Also, saying this is “un-American and anti-capitalist” is also wrong. Price transparency, fair competition, and breaking up middlemen cartels IS capitalism. Letting a few companies extort desperate people for life-saving meds is not “the free market.” That’s corporate racketeering and does not follow free market capitalism. And by the way, Trump didn’t just target Big Pharma. He forced price transparency for MRIs, hospital care, and all kinds of medical services, so patients can actually shop around and avoid getting fucked by surprise bills. Why the fuck is it only “bad” when a Republican president does it? It was never about principle, it was about politics. It was bad when Republicans did it under Obama, it is bad now Democrats are doing it under Trump.
Absolutely we could find plenty of allies on the left on this. However the guy identifies the issue and runs in the opposite direction of the solution lol. I work FP&A for a PBM. We are very creative on how to get margin. Trump would have to force us to give up “trade secrets” and establish regulators who will track every drug pricing movement across the formularies monthly. It’s absolutely true that Americans are a bunch of dumb rubes who enjoy getting bent over for their Rx while the rest of the world says no. It’s just that Trump isn’t the guy to fix this, he isn’t smart and doesn’t have smart people working for him who can fix this. And keep in mind how big Rx is. The 3 PBMs are Fortune 15s. The 3 wholesalers are Fortune 15. That’s 1/3 the F15 without even talking about the actual drug makers. These are the driving premier companies of the US economy. Trump isn’t up to this challenge, he’s only worked small time real estate BS, not actual real “businessman” shit.
I work for a PBM. Full of very smart actuaries, accountants and finance people. After all who else could make their product proves confidential, make their money on rebates and then hide them again offshore in a GPO. The GPO is kinda new as well. As a result of bipartisan efforts to get us to stop hiding rebates. In short, we are always 2 steps ahead unless other very smart and adaptable regulators can keep pace. The GOP doesn’t want regulation. They barely can agree of the IRS should collect taxes lol. So yea. Expect us to give orange man something that will absolutely fool him that prices are lowered and not be able to keep up. “Prices are now super low Mr Trump! (Ignore these fees that are now 90% of the price)”
This is beyond dumb. If you think this is anything but Trump propaganda, you are an absolute moron. For this to be anything, he'd need his ICE brownshirts to go kidnap the families of every drug company, insurance company, and PBM company CEO and threaten to send them to an El Salvadoran prison if they don't radically reduce their drug prices. And then pharma would go bankrupt.
You're completely ignoring the most likely outcome which is the PBM's get on their knees and beg for a compromise that doesn't completely wipe them out. Look at the amount of money they donate to both sides of the aisle and tell me if you really think they will get decimated. Near the money puts, maybe 10% of port, stop losses in place for the inevitable deal.
There's 3 PBM's that cover 90% of insured Americans that negotiate drug prices, it's not a lack of bargaining power.
Well said. I worked on a project for a PBM and all I can say is that they were shotty before but now they got bought up by the insurance companies they are wickedly sick and disgusting and it shouldn’t even be a real industry/job/service. It’s all bullshit and fuck em.
I’ve never worked for a PBM that gets manufacturer rebates, no one except Costco gets direct deals with any manufacturer and even then they have to take delivery through one of the big wholesalers. All of the “rebates” I see on the buy side are determined by overall purchase volume but it can vary based on the contract you sign. There may be cheaper generics available for purchase showing a rebate, but a lot of those don’t fall into the generic compliance program(Cardinal calls theirs “source”). The savings for generic compliance far exceed any rebates and vary greatly from store to store. One of the chains I work with expects to save a few million dollars by buying only Cardinal Source items, individual rebates may apply but don’t really come into consideration for savings on purchases.
He needs to go after PBMs then. Manufacturers are the same across countries, it’s the PBM middlemen that inflate the prices in the US just so they can then “cut” them only for their own members and justify their existence.
BUY THE DIPS Big Pharma and the middlemen (PBM) have a Federal Judge on standby to block Trumps price cuts
Used to be, I could get coverage for the Brand versions of all my medications. Sure, the out-of-pocket was outrageous, but I just expect to max out my deductible and max-out-of-pocket annually. Annoying, but that's the cost of living in the US without a pituitary. The other year, the most expensive of the brand pills fell off the formulary entirely. Full cash price or accept the generic. So after trying to cope on the generic, I gave up and dragged my technophobe, borderline senile, part-time endocrinologist through the Prior Authorization process. And the appeal, because appeals are required pretty much every time these days in this stupid godawful hellscape (I know this because of my injection, which is way more expensive and controlled than my most expensive pills). Anywho, the appeal worked. I had my doctor send a prescription for The Real Thing to my local pharmacy, who are lovely and competent. This was in a November or December, so all the categories were long since maxed out. Pharmacy calls me and says my prescription will cost me $1,xxx.00. This is rather unexpected; I was prior-authed. So I make some calls. There's a new category. It's the "mandatory generic penalty", and it applies to brand medications when there's a generic available. This "penalty" is an increase in cost of the brand medication to the tune of however much the evil people at the PBM suggest, and in this case, it's the whole price. And this mandatory generic penalty does not pay down either the deductible or the max-out-of-pocket. Neither is it affected both those being paid up. I had never heard of a category that's completely unaffected by the deductible or the MOP before. I took a chance, and I can report that when you order from Canada Med Stop, they send you manufacturer bottles in manufacturer boxes, if your total pill count matches a tidy multiple of the standard bottle. They tend to send from the country where the medication is manufactured. And they tend to be way cheaper than US pharmacies. But be prepared for the wait times, it can take weeks for the medication to be sent, and weeks to arrive. I hate this all so damn much. And it's really telling that Mario's brother comes from a rich family. Not even personal wealth can work around the problems anymore.
Yes, the senate hearing with CEO of Novo was quite the thing. The PBM's wants big "rebates" which they can get commision of, so the pharma companies need to jack up the price to give more artificial % rebates. There is no intention from the pharma companies, that people actually pay the listing price, because the listing price is just an arbitrary number based on how much PBM needs % rebates. PBMs favor higher list prices because rebates are typically a percentage of the drug’s price, increasing their profits. Novo even cut the price of one of their products some time ago (not one of the blockbusters). What happened? They reached less patients and was put in another tier and limited coverage. PBMs limit coverage to PBM-favored brands, excluding cheaper alternatives. This is your core problem in the US.