PBM OR PIRACY BY MAIL!!! THE STORY OF OUR DEAR BROTHER PHIL “FIL MY” POCKET, FROM PHARMACIST STEVE AND YOUAREWITHINTHENORMS THE THIRD & FINAL SERIES: EXTRACTING WEALTH OUT OF THE AMERICANS’ HEALTH AND WORKERS’ POCKETS

THE BIG 3 HOLDING ALL HEALTHCARE CARDS

reported in youarewithinthenorms.com

NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC., SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS, MD, PH.D., IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., M.B.A., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., EVELYN J. CLEMENT, IN THE SPIRIT OF WALTER F. WRENN III., MD., JULIE KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, IN THE SPIRIT OF WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., IN THE SPIRIT OF LEROY BAYLOR, JAY K. JOSHI MD., MBA, AISHA GARDNER, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS

The PBM FRAUD Script Scam: Profits AND DECEPTION Behind the Prescription Counter

Introduction

This video from the Pharmacist Steve’s Blog uses a satirical character named “Phil Fil My Pockets” to illustrate the controversial role of Pharmacy Benefit Managers (PBMs) as hidden intermediaries in the healthcare system.

The narrative reveals how these entities often manipulate drug pricing by marking up costs and accepting payments from pharmaceutical companies to prioritize specific medications.

The Invisible Player in Your Prescription

“The Hidden Hand in Your Medicine Cabinet: 5 Surprising Ways PBMs Control Your Healthcare Costs”

Ever experienced that sudden jolt of sticker shock at the pharmacy counter? You see the pharmacist, the medication, and your empty wallet—but you don’t see the architect of the transaction. There is a “man in the shadows” orchestrating exactly what you pay and which drugs to take. This isn’t a conspiracy; it’s the business model of the Pharmacy Benefit Manager (PBM).

Far from being a harmless administrative assistant, the PBM is a powerful intermediary that thrives on consumer ignorance. They are the architects of a system that obscures premiums and extracts wealth from the healthcare cycle. To understand why your costs keep climbing, you have to meet the persona behind the curtain: a character we’ll call “Phil Fil-my-pockets.”

The PBM Script Scam: Profits Behind the Prescription Counter

Pharmacy Benefit Managers (PBMs) prioritize specific drug brands by negotiating “sweet deals” with large brand-name drug companies. Under these arrangements, drug manufacturers pay the PBM to favor their medications over those produced by other companies.

Beyond direct payments for brand placement, PBMs use several other strategies to manage and prioritize drug access: Impact on Local Pharmacies

• Controlling Access: PBMs manage the “when, where, and how” patients receive their medications, allowing them to dictate which drugs are prioritized within a health plan.
• The “Script Scam”: PBMs may mark up the price of medications, charging the patient and the insurance plan more than what the PBM actually pays the pharmacy for the drug.
• Mandatory Mail-Order: PBMs often require patients to use mail-order pharmacies that the PBM owns, effectively cutting out neighborhood pharmacists and ensuring the PBM maintains control over the dispensing process.
• Restricting Choice: By “calling the shots” on pharmacy networks, PBMs can limit a patient’s choice of pharmacy, forcing them into distribution channels that favor the PBM’s financial interests.

Impact on Local Pharmacies

The PBM system significantly impacts both patient choice and local pharmacies by acting as a powerful middleman that prioritizes its own profits over accessibility and transparency
Neighborhood pharmacists often find themselves marginalized or financially squeezed by PBM practices:

• Exclusion from Care: PBMs can cut neighborhood pharmacists out of the process entirely by forcing patients into PBM-owned mail-order systems.
• The “Script Scam”: PBMs use a tactic where they charge the patient and the insurance plan significantly more for a drug than what they actually pay the pharmacy. This allows the PBM to pocket the difference, known as a markup, while the local pharmacy receives only a fraction of the cost.
• Positioned as a Barrier: PBMs deliberately place themselves between the patient and the pharmacist to rake in profits at their expense, often leaving the pharmacist powerless to intervene on the patient’s behalf.

summary conclusion

To reclaim scientific integrity and establish a legally defensible clinical standard, healthcare institutions must adopt the ASIPP 2023 Consensus Guidelines on Opioids. This framework offers a robust, evidence-based alternative to restrictive federal mandates, providing a pathway for clinicians to deliver care that is both safe and effective.

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