One thing we all hate is the high prices we pay in the US today for our prescriptions. Sure we do get some discounts, but that too has become an effort in algorithmic shopping to click here and click there to get the best price. It shouldn’t have to be that way,IMS Health Buys Cegedim Information Systems to Include CRM and Intelligence Software - Data Selling Business Gets Healthier and Wealthier But Can’t Say the Same for the Health of US Citizens - It’s All About Making Money Selling Data, The Epidemic
So yes in short, the big pharmacy benefit managers work in one way or another with the big pharmacy benefit managers and can add to the their bases of prescriptions filled using these cards as the card folks sell it to them. I wrote about how pharmacies and insurers are now doing what is called “medication prediction scores” on everyone, and be aware it’s a secret and you cannot get your score, but your insurer can. FICO does this and thinks that everyone should run around with a “score” on medication just like we do with credit, but the big problem is that the data is so flawed everywhere you turn for their prediction scores. It’s a rip on consumers. See what Express Scripts tells you about these scores, and worse yet, they “brag” about these scoring algorithms!
FICO Medication Adherence Scoring Should Be Banned As It’s Quantitated Justifications for Profit That Hurts US Consumers Using Proprietary Algorithms That Cannot Be Replicated For Accuracy or Audited
Medication Adherence Predictions Enter the World of Quantitated Justifications For Things That Are Just Not True, Members of the Proprietary “Code Hosing” Clubs Out There Destroying Your Privacy
Here’s another good video done with a taste of humor that explains the role of the Pharmacy Benefit Manager, the middleman cashing in big! It’s done well and the Pharmacy Benefit Manager is jumping all over the counter during the video, getting in the middle.
So in short, we are all getting ripped one way or another and have to “play this game” instead of just a simple process of filling a prescription. The government has their hands in this till as well as now pharmacists are seeing patients with the use of another prescription monitoring program called EQUIPP to see your “star” rating if you are on Medicare as far as medication adherence goes. Yes indeed, before you even show up data has already calculated a score about you that shows how they predict you will be with compliance. It’s a real nasty game, and oh yes, those folks who use cash to pay for prescriptions, well they are now called Outliers as they can’t track enough data on you, so if you like and want privacy, pay cash. Rite-Aid is the latest to announce using the data mining compliance software from EQUIPP.
Rite Aid Pharmacies are the Latest to Begin Used Flawed Data Provided by the EQuIPP Platform Relative to “Scoring” Patients for Predictive Medication Adherence–The “Outlier” Patients…
The flawed prediction scores are indeed a dangerous business as they will end up denying you access at some point as well. “Give old Jane the cheap stuff as our numbers predict she won’t take the expensive meds”…as a simple example.
Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to FixOutliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…
As a matter of fact, take a look at the first quarter revenue from United Healthcare, as their OptumRX revenue is exceeding that of the revenue produced by their insurance groups, more money made by United Healthcare with their OptumRX pharmacy benefit management companyUnited Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups
Look what else gets involved with OptumRX pharmacy benefit management, infusion drugs so they may show up to provide that service for you as well. The link below about OptumRX buying the infusion company has a side listing of a lot of government cronyism in healthcare too if you want to read about it.
There’s a company that’s a subsidiary of United Healthcare, OptumRX (United Healthcare) Buys Home Infusion Company AxelaCare-Using Algorithms To Determine Your Care With Being Financed By A “Too Big to Fail” US Health Insurance Company…
The discount card business has become very complex with just trying to get a prescription filled today and it’s done with complexities on purpose as everytime we don’t check something, we get fooled and pay more. This is what I call the world of the Attack of the Killer Algorithms as it is math models and computer codes that run everything so be aware, be very aware as it’s a game of being able to click for the right price anymore to the extremes and it shouldn’t be that way. BD
