Maureen "Mo" Thkacic is one of my favorite reporters.
She follows the money and does good shoe leather journalism, but in the story about UnitedHealthcare's pharmacy benefit manager (PBM) Change, and the hack that took its systems offline, buries the lede.
In a 25 paragraph article, you have to wait until 'graph 21 to get this: (It's a good article otherwise)
In Utah, one of the states whose Medicaid program uses Change, the week has been oddly liberating, says Benjamin Jolley, a compounding pharmacist and self-described “anti-monopoly crusader” in the state. After working through the weekend to reach out to tens of thousands of patients with unfilled prescriptions in the system, the state decided to simply put together a simple four-question Google form for pharmacies to file requests for reimbursement until the system is back up and running. “[It’s] janky and hacky, but it does the job,” said Jolley, who has filled $1,500 in Medicaid prescriptions since the outage started and filed for reimbursement yesterday. “Presumably if anyone asks for an abnormally high figure they’ll look at their history and give them a call.”
Google docs? Seriously?
Based on the total kickbacks and fees received by PBMs in 2022, it looks like PBMs got something north of $700 million last year in Utah alone.
They were replaced with a single Google form.
Obviously, there are some additional state resources, the requests for reimbursements need to be reviewed by someone, but given the number of pharmacies in Utah, 1,117 at current count, the initial review could be handled by one low level full time equivalent, at less than $100,000.00 a year including benefits.
That is a 700,000% savings.
It's the looting, stupid.
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