Have you heard the phrase, “It’s expensive to be poor”? This concept is often illustrated by a pair of boots: an individual with less money can only afford an okay pair of boots for $30, within 2 months, they need to be replaced and another $30 is spent; a pattern emerges. An individual with more money can buy a good pair of boots for $100 and they may last for well over a year. In the end, people who have the money to spend a little more upfront often end up spending less in the long run. This same concept can be applied to many facets of life: buying a car, buying items in bulk, and, unfortunately, health insurance coverage as well.

High-deductible health plans, or HDHPs, are health insurance plans known to have the lowest premium but also having astronomical, often unattainable, deductibles. With a higher deductible, individuals are then responsible for a significant amount of out-of-pocket health costs before insurance coverage kicks in. While HDHPs are incentivized by their joint offering with an HSA savings account, which do boast incredible tax advantages (that very few know of or can even take advantage of), the plans are wrought with disadvantages as well.

The Problem with HDHPs: Care Avoidance

HDHPs particularly affect low-income individuals and families who struggle to afford the upfront costs of medical care. A recent study found that in companies employing low-wage workers, nearly 46% of those do not have sufficient savings to cover their annual deductible costs. Unfortunately, this has a domino effect.  While the insurance premium is more reasonable, the threat of additional costs looms dark overhead due to its complex nature and lack of transparent healthcare pricing. Almost 52% of adults could not afford an unexpected medical bill of just $500 without going into debt. As a result, those in HDHPs are less likely to seek medical treatment even for preventative care that would be covered by the plan because of the fear of unpredictable costs and a general lack of understanding of their benefits.

One could argue that the increased out-of-pocket costs could deter members from seeking out unnecessary care. However, those with chronic conditions, in which continuous care is critical, avoid treatment far outnumber the small sum of people deterred from seeking unnecessary care. According to a survey conducted by The Commonwealth Fund, “Thirty-eight percent of adults enrolled in HDHPs either did not fill a prescription; skipped a recommended medical test, treatment, or follow-up; or did not see a specialist when needed.” Additionally, the KFF found that 1 in 10 adults had said they have cut pills in half or skipped dosages due to the high cost of medications. 

Their reluctance to seek help for small, oftentimes preventable health issues can result in medical emergencies or lead to chronic conditions, thus ending up costing them more in the long run. They’ve bought the cheap boots and entered the endless cycle. 

An Employer’s Responsibility

While an HDHP is riddled with flaws, more and more employers are offering these plans to their employees as the least expensive option for medical coverage, despite employees largely being unable or unwilling to use the plan at all. According to Towers Watson, the jump from employers offering HDHP plans went from 54% in 2019, to 86% in 2023, with enrollment in these plans more than doubling from 20% to 43% in the same time frame.

I was one of the brokers offering and suggesting these plans to clients as a plausible solution. On the surface, it’s an attractive offering with the potential to solve many surface-level issues. I now see how short sighted that was since it isn’t possible for consumerism to exist in healthcare. Changing the plan design created immediate savings in premiums but changed nothing as it relates to the rising cost of offering coverage in the long run.

Unfortunately, once employers begin offering these plans, they become stuck in a loop themselves. As the cost of insurance plans rise, they’re forced to pass those costs onto their employees by increasing the premiums for the plans offered.  Employees who cannot afford the increased rate for “decent plans” settle for the cheapest, aka the HDHP plan. 

Breaking the Cycle

In short, our healthcare system is broken (in more ways than one). But one cannot “insurance their way out” of our broken system. Employers are struggling to pilot this mess on their own. They’ve become complacent in their offerings and relegate themselves to accepting things as they are because that’s how it’s always been. HR simply follows the status quo and leadership fails to challenge them to find alternate solutions. 

I often get questions about how SHARx can work with an employer’s HDHP plan; that’s not the right question. The question you should be asking is: how can I enhance my health plan offering by mitigating inflated, unpredictable costs to invest in plans that take the burden off employees?

By implementing SHARx, a pharmacy procurement solutions provider, employers can reverse course and use the impact of working with SHARx to enhance their health plans to get to a place where employees can understand and value the amazing benefits their employer is offering to them. By opting out of an ineffective plan structure (that is constantly decreasing in value), employers can break out of the endless cycle of simply providing the “cheap boots.”

The post Giving Your HDHP Plans the Boot appeared first on SHARx.

Big Pharma is at it again. They have collectively released their minions to concoct a new moniker: Alternate Funding Programs (AFPs).

According to several articles found on the internet, SHARx finds itself lumped into a category that is based on a fictious representation of our business model and mission. On numerous occasions, we have been referred to as an alternative funding program (AFPs) by profit-centered people painting a broad stroke across loosely connected parties in an effort to keep the American public paying 256% more in prescription costs than the rest of the world. I am setting the record straight.

AFPs profit on the problem by charging a percentage of the manufacturer’s retail cost, falsely aiding those whose plan still covers the drug. They also rely exclusively on manufacturer programs such as patient assistance programs (PAPs) whereby the manufacturer providers a medication at no or low cost to a patient that meets the criteria of the program. PAPs are one of the many resources available to people, but only if they do not have insurance coverage for their medication. While SHARx helps those without coverage find ways to procure their medication, which sometimes includes PAPs (if the individual meets their criteria), we evaluate all available options to ensure our members have affordable access to the medications they need, without delay.

Profitability vs. Purpose

A common business model for the AFPs is to share in the success of getting a medication provided by or funded by a manufacturer program via a percentage of savings.  They make more money when the drug costs more (profit on the problem). They only get paid when a member uses their service, creating a misaligned incentive to only work on the most expensive medications.

On the contrary, SHARx has a materially different business model. We offer a predictable, flat fee option that remains the same regardless of which medications we assist with. Consequently, we are not incentivized to rely on any particular sourcing option, and our clients do not pay more when another one of their employees (who lacks coverage) needs a high-cost drug.  Our entire team understands the importance of what the member needs because SHARx was founded to help solve an issue that I personally experience. My own children live with a rare condition that requires expensive medications approaching $2,000,000 per year.

SHARx is a supply-chain management and procurement solution helping employers honor their fiduciary duty to the plan, while also ethically providing a liaison for their underinsured employee. Conversely, AFPs rely on a specific tactic of manufacturer assistance and sometimes by tricking the system. Their entire business model is founded on navigating the confusing system of manufacturer coupons and patient assistance programs, while taking a cut of the profit at the same time.

SHARx is an ethical sourcing entity that utilizes a plethora of tools, channels, and avenues to ensure affordable access to medications, outside the confines of insurance, while the member is being guided by experienced, knowledgeable advocates. SHARx fervently advocates for members because we are all stuck in a system that was never built for the patients who need the medications or employers who are funding the bill.

Setting A Higher Standard

With the right guidance, there are many channels that people can tap into to get affordable access to their medications. While there may be companies in the market that offer services meeting the definition of an AFP, this term disparages SHARx, sought to make us guilty by association, and does not remotely portray who we fight for, the extent of our capabilities, and the importance of our mission.

The post The SHARx Difference appeared first on SHARx.

On February 8, 2024, the CEOs of Johnson & Johnson, Bristol Myers Squibb, and Merck were challenged by the U.S. Senate HELP (Health, Education, Labor, & Pensions) Committee to disclose their reasonings for the outrageous drug pricing in the U.S. They discussed the role of PBMs, patents, free market apprehensions, advertising budgets, and concerns regarding how Medicaid and Medicare can cover these expensive drugs. Amidst the heated conversations, Sen. Bernie Sanders confronted the Big Pharma CEOs with a powerful, and resonating, statement: “Your lifesaving drugs mean nothing to millions of Americans who cannot afford them.”

Naturally, Big Pharma’s response was the recurring narrative that their commitment and investment is focused on “Research & Development”. While R&D is necessary to advance the potential for upcoming and currently listed medications, the term is also often used as a scapegoat for where profits are being allocated while little to no proof is required for that spending.

The Senate countered this claim by highlighting the exorbitant amount of money that they are also spending on advertising costs, patent extension and lawsuits, and shareholder profits. As an example, Sen. Chris Murphy pointed out that Johnson & Johnson allocated $17 billion toward stock buybacks and dividends while only dedicating $14 billion to R&D efforts.

Backpedaling, Big Pharma then points the blame on the traditional PBMs, stating that the actual cost of medications have not increased substantially, rather it’s the PBMs that are hiking up the prices and taking more than the lion’s share. While some fault might lie with the PBMs, both parties are complicit in the action. These conversations are ineffective and do not lead to any tangible solutions. So, in a situation where everyone is complacent, everyone is making money, and no one’s bottom line is being impacted, why are they even involved in this conversation? The problem is that the user of the service and the payer of the service have been taken out of the dialogue.

If you want to solve this, talk to the people who are in the middle of all of it. As an advocate for affordable healthcare solutions, particularly in the prescription drug space, I would start with significant fundamental changes to the unchecked spending of pharmaceutical advertising and the corrupt relationship between PBMs, the manufacturers, and rebate programs.

Reducing Advertising Costs

The United States is one of only two countries in the entire world that allows for pharmaceutical drug advertising. The amount of exposure that Americans get to these advertisements is overwhelming. Nielsen estimates that, on average, 80 pharmaceutical ads air each hour on television. And not only are audiences inundated with clever and hopeful marketing messages, they are being guided to medications that can charge significant amounts of money despite having insurance coverage.

This doesn’t even begin to touch the surface of how Big Pharma’s ad spend can manipulate the media companies, influence consumer behavior, and more. Big Pharma has surpassed $8 billion spent on advertising annually and their primary goal is not to help the consumer, but to sell the product. Think of the medical advancements that could be made if that money was redirected into actual R&D.

Eliminating Rebate Programs

PBMs negotiate formulary placement and in doing so extract bribery from Big Pharma with rebates. Express Scripts, CVS, and Optum control 80% of the entire population’s access to drugs so if the manufacturer’s drug is not on one of their formularies, a third of the U.S. population does not have access to available medications. Formularies should be based upon clinical effectiveness and value, not bribery. If a drug works better than another drug, then it should be on the better version of the formulary because of its efficacy. They are not negotiating drug prices; they are negotiating rebates.

In my opinion, Congress should stop allowing rebates to exist at all and make them just as illegal in the healthcare industry as they are in many others. You cannot pay for performance in any other industry but somehow healthcare, specifically the PBM world, has found a loophole. Traditional PBMs would lose their minds if they had to give up rebates because everything they do is dependent on them as they add significant value to both customers and shareholders.

Moving Forward

In short, there is a lot that needs to be done to reign in the unprecedented spending of Big Pharma, but the fact that our government is beginning to take note of public outcry is promising. We’re here to convince leaders to bring the right voices to the table.

We have to get the government and the media out of Big Pharma’s pocket. I would love it if SHARx didn’t have to exist and that Americans had affordable access to life-saving medications no matter their income but until that becomes a reality, we’ll keep fighting the fight and continue advocating for those who need us.

The post The Solution to High-Cost Drug Pricing in the U.S.: Having the Right Conversations appeared first on SHARx.

Sticking to Our Values

This does not sit well with us at SHARx. We were built on a set of core values that propel us to help those in need. We have empathy for our members because we know that they have also struggled to access the medications that they or their families need. That unity is what drives our commitment to this shared goal. We focus on our dedication to our members and put forth effort on their behalf. We practice adaptability, consistently striving to get the job done. We have perseverance and will not be deterred. Last but not least, we maintain integrity in everything we do.

So of course, we are suing AbbVie… our core values demand it. These values insist we fight for those without a voice. We would not be the company we promise to be if we let this slide and cower in the face of the bully. We know that our members will have no one on their side if we are unwilling to fight on their behalf. We did not ask for this. We would have been content to grow our business by helping people who need us. But when AbbVie tried to bully us, they chose the wrong team. They underestimated our commitment to living our core values every single day, a commitment we held long before those values were officially established.

Fighting the Good Fight

So long as we continue to live our core values, we cannot lose. We have helped hundreds of thousands of people and their families live and live well. To me, that is the definition of winning.

I am so glad we are in this fight together. I look forward to standing up to this and any other bullies who foolishly underestimate our dedication to our members. We will not back down; we will always fight for them.

The post Standing Up For What Is Right appeared first on SHARx.

The Cold Hard Facts

According to BenefitsPRO, 93% of employers considered switching pharmacy benefit providers in the last year due to the rising cost of prescriptions and complicated PBM contracts; smaller employers are more likely to re-evaluate their pharmacy benefit plans than very large employers; and future company health plan designs greatly concern majority of employers (BenefitsPRO, 2023). 

Prescription spend continues to exponentially rise in the United States. Unfortunately, there is no end in sight to this problem significantly impacting company bottom lines and many employers are searching for new health benefits that will positively impact the trajectory of their company in the coming year(s).

Analyzing the Tool Belt

Healthcare is episodic, meaning there is a start and end date. Most medications, however, do not have an end date making them a reoccurring expense. Insurance is designed to cover the risk of unknown loss making this the wrong tool for this problem. Insurance makes services, including medications more expensive. Almost every medication is cheaper without insurance if you know where to look. That is the key!

Employers are Craving Change

The first step in making a change is recognizing that the tool employers have been using was never meant to take care of this problem. The next step is to acknowledge insurance is the wrong tool and seek out a better one. Just like any other expected expenses that companies plan for, procurement, not insurance, is critical for having confidence that those expenses are managed properly. 

Many employers crave the change that prescription procurement can provide. However, they may be unaware of the treasure. Prescription procurement is a high-value strategy utilized to effectively acquire a medication that a person needs. It allows employers to give their employees a better experience, not just have the option to access mediocre discounts on high-cost medications at the local pharmacy and deal with the bureaucracy of insurance.

A Financing Vehicle? More Like a Roadblock.

A self-funded employer acts like a traditional insurance company, collecting premiums from enrollees and taking on the responsibility of paying employees’ and dependents’ medical claims. It makes sense that they would hire PBMs and expect them to make sure that all expenses are essential and appropriate. The higher the cost of the drug, the more questions will be asked. To get answers to these questions, it puts patients in the middle. This often creates obstacles to care, causing frustrations with prior authorization protocols that, while necessary, are suffocating to a member just trying to take the medication their doctor prescribed.

It becomes an aggravating exercise with members and providers trying to prove that the medication they are trying to fill is needed. It frequently involves letters from the provider explaining why the member requires a specific medication while trying to steer the member to an alternative therapy, which is usually based on rebates to the PBM and not clinical outcomes.

It is assumed that if a patient does not use health insurance, it is impossible to afford the outrageous cost of the medications, but the reality is that insurance is the element patients cannot afford to use. This is where the illusive value of insurance comes into play.

A Fair Cash Price

No doubt, PBMs are incredibly smart and good at making money, so they put prohibitions on your local community pharmacies from offering patients fair cash prices. If there was value in having health insurance, then not having health insurance should make things harder. However, not having insurance has continued to prove that it actually makes things cheaper and simpler. From personal experience, I have learned when you stop asking for permission from insurance companies to attain what you need, the entire process becomes easier.

To further illustrate the point, cash only pharmacies, like Mark Cuban’s pharmacy, do not accept insurance and the prices are better than local retail pharmacies any day of the week. Why? Because not participating in insurance allows them to offer patients a fair cash price. The second a pharmacy benefit network enters the picture; a fair cash price is prohibited. This is what entangles most companies today.

Adjusting the Tool Belt

By implementing the right tool, (aka prescription procurement), a more predictable healthcare budgeting process is created. It allows employers to take control over what is being offered and how it is being offered.

Employers and employees alike despise the oversight and burden that using insurance creates, but they are not sure that they have any other choice. They do and SHARx is here to help. Trying to negotiate a better discount and rebate has never and will never solve this dilemma because that relies on the system that created the problem to also have the solution.  To truly solve this issue, you have to opt out of the system and only then can the answers be found.

SHARx exists to serve members that have been lost in this journey – the employer and the employee. Our passion is to give the ‘lost’ a voice and seat at the table. Unfortunately, other parties involved in our healthcare system profit on the problem, but that is not what we do or why we do it.

The SHARx Solution

SHARx navigates this messy healthcare issue with knowledge and expertise to lead our clients in a direction that benefits all parties involved. There is great value in the experience SHARx brings to the table when routing these debilitating problems that individual employers might greatly struggle to pilot on their own. SHARx is made up of trained individuals who have done the research and continue to do so. We know what to do and where to go for the members that need our help.

We believe people deserve to get what they need. With SHARx, employers can control one of the bigger variables in the game which are the medications that insurance was never meant to control anyway.

The post A New Approach appeared first on SHARx.

Are You Sure About Insurance for Medications?

Insurance was meant to cover the risk of unknown loss. Many Human Resource managers have implemented pharmacy insurance into their companies’ benefits because it has been engrained in them that insurance is what you do for your employees. However, in doing so, they are often creating a major roadblock to their company’s success. Many employers are finding insurance has made covering high-cost medications for their employees unstainable, causing businesses to struggle to stay afloat. This makes sense when you realize that medications are a very known and predictable expense.

The insurance administration is outsourced to pharmacy benefit managers “PBMs” causing employees to jump through hoops and fighting just to get medications crucial to a person’s survival, which sadly has become the ‘norm’. These hoops include things like the prior authorization process and dealing with the PBM owned pharmacy. Many employers have found that insurance essentially suffocates the process, causing frustration for them and their employees. Perhaps there is a better solution than using insurance for predictable expenses.

Navigating the Machine

No one enjoys navigating a bunch of inconvenient steps. PBMs claim to provide great value but time and time again, they have demonstrated through complicated processes that they neglect the care for the patients and their struggle to secure the medications they need.

Unless you have experienced the process, you may be unaware of the navigation that this takes. Many members are under the impression that there is no other way to attain their medications. As a society, we have been conditioned to believe the big machine known as insurance is the only way. Employers and employees are waving their white flags begging to be disrupted from their current situations. Fortunately, there is another way for those employers that decide to opt out of a system that was never built for them or their employees to find a better path.

We have been told that insurance is necessary to afford to seek care and manage disease. In my experience, using insurance creates so many headaches and barriers to accessing needed medications. Employers are at a crossroads of needing to find a way to offer a health plan that is sustainable and taking care of their most valued asset, their employees. But what can they do about it? By using the right tool for the problem, I have learned attaining high-cost medications becomes affordable and simple.

Breaking the Barrier

Suffering in silence is real. An absence of people complaining does not mean that the current process is working. My philosophy is that if you value your people, then you should provide them with something better.

SHARx understands that there is an issue. With positive disruption, employers have the option to stop using insurance for those expected expenses as it has proven to be an unsustainable solution. By partnering with SHARx, members gain access to prescriptions they need in a much simpler way, bypassing all the headaches that insurance causes. When selecting this avenue, insurance is no longer a barrier to getting medications.

There is always the option to stop covering drugs and never hire SHARx to help but is that any way for employers to show that they actually care about their people?

For Eric Hasty, CFO at Buchheit and longtime SHARx client, caring for his employees is top priority. He explains, “It would go contrary to our values as a company to not have an option for these folks. If we care about our team members, we put resources behind a health plan and we want it to work for them. This is a way that allows us to really benefit the team member even more and save those astronomical costs”. Hasty chose to opt out of the insanity and hire SHARx because he valued his company’s people. He took a stand, and his business and employees have benefitted tremendously.

A Biased Mentality

As a former broker, I will admit that we created the insurance bias and promoted the use of insurance. This bias causes employers to feel as though they need to have it. However, there comes a point in time when many employers find that they cannot sustain the rising cost of health care. They recognize that their original choice is not serving their business any longer. They have done the best they can with the plan they were given with the information they had.

Changing the Narrative

Expectations of our current systems have gotten us to where we are today, so it is important to define what is possible. It is possible to change the mindset that many of us have had about insurance up until now. I know because I lived in this world and played the game too. I realized that I was just as complacent as everyone else until I had a need for a high-cost medication for my children and had to face the music. I was unaware of the frustrations and limitations that were in place until I was forced to be a hyper user of health care.  I recognized that the answer to my problem as the patient was not more insurance but rather less. It was a realization that changed the way I viewed the entire process.

Moving forward, we can change the way in which we think about solving some of these issues. What if you or your clients took a stand? What if you decided to join in with your peers in choosing to make a decision to do something different?

Prepping for the Future

Every year, employers must make tough decisions. Many choose to eat the cost of high-cost medications for their employees but at some point, everyone hits the end of the line. Unfortunately, the smaller you are the faster you hit that wall. Our goal at SHARx is to get rid of the headaches altogether.

For Brian Hall, CFO at McCray Lumber and SHARx client, the end of the line was quickly approaching, and he knew had to make a valuable change for his company. Hall encourages HR managers contemplating to take the leap as he states, “I always tell them that you never know when something is going to change. You need this, your company needs this. The only push back and the folks that don’t engage immediately are ones that don’t believe they have a problem, but they could have a problem next week. You never know when you are hiring people what kind of issues they have when they walk through the door or what you are getting and how they are going to affect your plan.” He emphasizes the importance of getting in front of the problem before it ends up being too late and companies are forced to shut their doors. Are you ready to take the leap?

The post Taking the Leap appeared first on SHARx.

Disruption is a good thing! To put it simply, disruption means to break the normal course or continuation of some activity, process, etc.

To many, disruption alludes a negative connotation. With disruption comes change. Change is scary because it opens the door to the unknown. I am advocating to change that narrative. Change needs to happen. It allows companies to test new approaches for the betterment of their business both internally and externally.

Human Resources and the Standard

For many Human Resource managers, the thought of making changes to a company’s health plan seems terrifying. Through the years, I have found that one of the biggest reasons why a potential client declines the services of SHARx is because HR does not want to disrupt their current processes.

Truth be told, most health plans produce headaches, but HR departments continue to implement what they know believing that their employer and employees like it. In reality, almost no one likes it. However, most HR departments are too afraid to stop what they are currently doing because of the unknown outcomes.

Taking the Leap

Disruption can be positive if done the right way. Sometimes it just requires taking the leap of faith.

Brian Hall, CFO at McCray Lumber and longtime SHARx client, took that leap and he’s glad that he did. Hall states, “If you roll it [SHARx] out, the implementation is not near as painful and if you explain it, just be open and upfront with your people and all your employees. They’ll understand and ultimately, they’ll embrace it and view it as a large benefit like all the rest of us do. If HR looks at this and says we are going to give it a try, they could end up being a superstar in the eyes of their finance people. If they roll it [SHARx] out and have the kind of experience that all of SHARx’s clients have, they will end up being viewed as a superstar.”

Empowering Everyone Involved

Hall decided his blue-collar marginalized company needed disruption. Where margins are thin, every dollar matters. Hall recognized his company could not stay on the same path it had been on for the past two years. Instead of trying to get better insurance, he stopped letting insurance dictate what happened in the health plan. Hall turned to SHARx to empower his employees.

Year after year, the trend line on the cost of their medications continued to rise despite shifting cost share to the employees and moving PBMs regularly.

It would have been simple to just exclude these drugs from coverage, but Hall wanted his employees to have access to the medications they needed and knew that something had to give. “Maintenance medications – It’s a bill that the employer sees on their plan month after month as long as that employee works for them instead of a $20,000 surgery that would go away,” says Hall. He needed a way to solve this financial dilemma for his company without losing some very valuable team members and knew there had to be a better way.

By taking a stand early, utilizing what was available on the market, and attaining access to it, Hall was able to keep premiums the same, no longer had to pay for the drugs that he had to pay out of pocket for before, and reinvested the savings into keeping his employees’ cost shares flat. By implementing SHARx, Hall took back control of his company.

We do not have to accept the status quo. Doing something different can benefit your clients both financially and administratively. Disruption is a good thing! Are you ready to take the leap with SHARx?

The post Disrupting the Norm appeared first on SHARx.

I’ve spoken many times about my children’s genetic condition known as Cystinosis. Having children with an illness is stressful enough, but it is made more stressful by the cost of the medication needed to treat their illness. A few years ago, the manufacturer of their medication was acquired by the company Horizon Therapeutics. Learning more about Horizon’s rise within the pharmaceutical industry was enough to make me sick!

Horizon got their start in 2015 and in a relatively short period of time has racked up a collection of crucial drugs worth billions of dollars without ever licensing a product it invented. How they did it serves as a great example of the brokenness of the drug industry. Click here to read more about the rise of a company worth billions that never made a single product.

On the Market

When Horizon acquired the manufacturer of my children’s medication, the price of the drug increased by 50% in a short amount of time – from $50,000 to $75,000 a month per child. They are able to charge these ridiculous prices because the reality is that people with Cystinosis must take the drugs needed to treat it or they likely will not live past the age of 10.

I am disgusted that this company and its leadership has made so much money on the backs of people like my family. However, I am actually glad they were acquired because things can only get better from how it works currently.

My Own Experience

In addition to the exorbitant costs, to make matters more difficult, the drugs that my children take are limited distribution. This means only one pharmacy in the entire country can fill their prescriptions and, in my case, it is a big 3 PBM owned specialty pharmacy. As a parent, I do not have a choice as to which pharmacy I can go to, and I can tell you from experience that service is not important to the pharmacy I am forced to use. I am not picking on this particular pharmacy as I have used 3 of the 4 largest specialty pharmacies in the country and the experience was just as awful each time.

In some cases, I get placed into what is called a bridge with my manufacturer and they use a special pharmacy (the same pharmacy that would be used if I were eligible for PAP) to send me my children’s medications.  This normally happens when the pharmacy screws up so bad, my children will run out of medication without intervention.

When using this special pharmacy, I have delightful experiences and am envious of those who get to use them on a regular basis.

The Rise of SHARx

Companies similar to Horizon were my motivation behind why I began SHARx.

Drug companies and manufacturers make millions and billions of dollars by jacking up the prices of their medications. Most people attempt to pay for their medications until they can no longer afford to. Many employers are faced with this same dilemma. With insurance, employers are forced to find ways to pay for that one person that costs more than everyone else combined. At SHARx, we recognize that you cannot “insurance your way” out of this problem. It is not working for employees or employers.

Addressing the Now with the SHARx Solution

SHARx’s mantra is to solve the problem now before you face it head on. We live in a very broken system, and it is only a matter of time before an employer is faced with making those tough decisions. Even if an employer is not currently dealing with these issues, it is likely what the future holds. The average price of a new medication is rising dramatically. Employers must be prepared for when they eventually feel the sting of high drug costs.

People make the best decisions with the information that they have been given. Unfortunately, many people using the broken insurance system have not been given the information needed to make sound decisions. That is where SHARx steps in to let people know that it does not have to be this way. For me, I once was the broker. I was coming from the top down, but becoming well-versed in the industry has made me realize the importance of coming from the patient up. After all, that is where the process starts and ends.

Applying Business to Medicine

I have half a million reasons that illustrate how pharmaceutical giants do not really care about the people using their products. It is frustrating to see how companies like Horizon exploit people like my children for financial gain, yet they use their faces in their advertising. These are young children who suffer every day from a disease they did not ask for and are being used as marketing subjects. They want people to believe that as a company they care about the people taking their medications and desire for them to get better. However, they really want people to take their drug as much as possible for as long as possible. 

If you ever ask big pharma why they charge so much, their answer is always about their research and development. Though, when you poke holes in that facility of an excuse, the answer becomes ‘because we can’. They exponentially recoup their investment. It is really about ROI, not R&D. Essentially, they applied business to medicine. 

Stop Playing the Game

SHARx wants to help people who do not have a seat at the table with the drug companies and insurance giants. Too many people are being forced to play games, by companies like Horizon, that they cannot win because they are in the system that beats them down and wears them out. They are tired and not speaking up has become the norm. We want to change this narrative and disrupt the corrupt system. Our goal is to stop the game and liberate the member from the system that was never built for them.

The post Facing the System Head-On appeared first on SHARx.

The pharmaceutical industry has an ethics problem, but if you listen to many of the “talking heads” for Big Pharma, they will have you believe that it is the employers, looking for solutions so they can maintain/achieve financial solvency while doing right by their employees, that are being “unethical”.

Under the Insurance Umbrella

In the United States, pharmaceuticals are jammed under the insurance umbrella because most Americans need insurance coverage to help cover the cost of their prescriptions. However, many people paying for health insurance struggle to exist in a state of financial security. It is difficult for many individuals, but it is often even tougher for employers, tasked with carrying coverage for all or many of their employees, some of whom are taking high-cost medications.

Illusive Value

The insurance machine creates dependency on itself by making it seem like we need it to survive. Health insurance advertises itself as a method to protect individuals from health risks and businesses from financial ruin. Armed with the illusion of value and convenience, it leads many people to believe they have a network of support. 

The Network is Broken

The sad reality of the situation is that the insurance system/network is broken. Traditional Pharmacy Benefit Managers (PBMs) manage this network and the top seven PBMs have a 96% market share while all the other PBMs fight over the remaining 4%.

These popular PBMs have deals with thousands of pharmacies nationwide and patients can go to them for their needs. Additionally, they answer the phone calls and adjudicate claims, which can give the impression that they have the public’s best interest at heart. However, they also negotiate with the manufacturers. This negotiation is for a floor position on the formulary which is essentially a tiering system of bribery. If you are unfamiliar with the term “formulary”, it refers to a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. It is sometimes referred to as a “drug list”.

Playing the Game

If a drug is in the formulary, then a member can get their drug since someone will pay for it. The PBMs hold all the power and are on board with this set-up as long as the manufacturers continue to pay them. If that ever stops, the manufacturer believes they are out of the game. This is why the manufacturers continue to raise their prices, to satisfy the PBMs appetite for larger rebates and increase profit for shareholders when they can.  

While PBMs and drug manufacturers are playing power games with each other, employers and individuals are the ones coming out on the losing end. 

Whose Money Is It?

The user of the drug and the payer for the drug have no seat at the table whatsoever. Health insurance networks and carriers can play, but they are not playing with their own money. Whose money is it you might ask? The employer’s. The employer pays the premiums and claims. This is part of why we get the cluster that is the U.S. healthcare system. It is understood that the worse things get from a health perspective, the more profitable it is for Big Pharma. 

Stuck in the Cycle

Employers are stuck in the vicious cycle of what the United States healthcare system has become. If you ask yourself, “Why am I using insurance to pay for things that are routine and expected?”, the answer does not make much logical sense. Employers are forced to go outside of the system since they have limited options to escape the cycle. 

The Ethical Solution

Employers are forced to make tough decisions, such as to exclude certain drugs from their healthcare plan because they cannot afford the medications and sustain the nonsense. SHARx is the service that employers otherwise would not have to ensure their employees are taken care of.

Employers are making the choice to stop playing the insane game in a nonpainful way. It is about realizing that when health care budgets cannot be predicted or controlled, things suffer. Procurement and enhancing the experience of the member is the answer.

At SHARx, we have a passion to take care of the lost members in the system that was never designed to serve them and who are not being taken care of. We make sure that members get what they need in an affordable way. We strive to allow businesses to be sustainable and have solvency moving forward.

With SHARx, it is possible for employers to do what is right for the people who matter most – their employees.  

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The pharmaceutical industry is addicted to making money. So much so that they refuse the recommendations of experts and doctors to protect their own financial interests.

In an industry that should be patient-centric, off kilter priorities have led to decision-making based on profits rather than people. Often, Big Pharma prioritizes things like marketing and financial gain over the condition and wellbeing of patients. The results of that industry having its priorities out of whack are undesirable health outcomes and extraordinarily higher pricing for patients seeking necessary and, in many cases, crucial treatment.

This was true when I was navigating the healthcare system back in 2017, trying to secure high-cost medications for my family members, and it remains the same today. You may be asking yourself, “Why would companies that claim to help us and improve our lives, behave in a way that is highly unethical?”

Dog Eat Dog World

Simply put, increasing existing wealth remains the primary focus of the pharmaceutical industry, but they never say that publicly.

The values upheld in the industry fuels the existence of companies that align with these values. They choose to indulge in the current environment rather than systemically uproot the misguided motives during current philosophies.

Lobbying & the Internet

Consider the political action agenda: Many industries lobby elected officials to keep themselves afloat. Lobbying is a practice that has been going on for years, but now industries are no longer solely dependent on government officials to push their agendas through. These traditional Pharmacy Benefit Managers, wholesalers, manufacturers, and pharmacies can simply turn to the internet as an additional resource to further their deceptive narratives.

As of January 2023, the Internet reached over five trillion megabytes of data. It now serves as the most influential source of information, but not everything we discover on the Internet is reliable, true, authentic, or correct.

Moreover, misunderstandings; honest mistakes; exaggerations; and disinformation spread with a malicious intent can cause people to make poor decisions for themselves and their company.

Monopoly – It is All a Game

The conventional pharmaceutical industry is perpetually feeding false information that continues to enrich an industry making billions of dollars in revenue. To carry on the charade, they continue to paint themselves as fledgling organizations with limited resources.

This has created a monopoly, ensuring the patient in need stays dependent on them for survival. But below the surface is the revelation that scarce resources and billions of dollars in profits do not go hand in hand.

Three Ways to Spot Misinformation

Many are unaware of what happens behind the scenes because we lack ‘inside’ information, and the pharmacy giants are masters at manipulating their public message to meet their agenda.

It can be difficult to see the true intentions of any given source. Through my own experiences, I have found three ways to gain a more critical eye with the things I’m seeing:

1. Check for Biases. Does the source have a financial interest spin on their message?
2. Read Between the Lines. What is not being said? Are there any parties being protected or omitted from the story?
3. Is it true? Just because it is in writing, does not make it true. I often see the same talking points echoed across various platforms and a lie said multiple times is still a lie.

Misinformation in Action

I’ve seen the talking point in several articles that states “alternative funding organizations are robbing from charities which will leave the destitute without access to medications.” While this is certainly an emotionally charged statement, let’s apply our three criteria to this and see what we find.

1. When checking for biases it comes clear that each party that makes this claim has a close financial tie to Big Pharma.
2. These articles will point fingers at many parties, like PBMs, specialty pharmacies, and even SHARx and yet they never acknowledge the role that Big Pharma plays.
3. I know exactly how the patient assistance foundations are setup and to call them a charity with limited resources is just simply not true.

Time for an Awakening

My advice to you, the discerning consultant: do not be fooled. As a trusted advisor, you can push back against the deception and bring light to your clients and their employees. Be the hero for those who are desperately lacking both the coverage and the understanding needed to receive the treatment they deserve.

We will continue to advance into turbulent territory with the same enterprise and passion as you have come to expect.

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