In the drug industry, there are different types of abusive practices that occur:
- Drug companies encouraging off-label use (and/or “recreational” use) of their drugs, potentially harming patients’ health.
- Drug companies encouraging doctors to increase dosages and drug use, potentially harming patients’ health.
- Drug companies encouraging waste to increase the volume of drugs sold.
- Pharmacy benefits managers (PBMs) selling out their clients (payors) in exchange for kickbacks from drug manufacturers.
- Drug manufacturers using “specialty” pharmacies to bilk payors, tricking the payors into reimbursing expensive drugs that they would otherwise not reimburse. Unlike traditional pharmacies, captive pharmacies can go the extra mile to obtain (possibly improper) drug reimbursement for the drug manufacturer.
This blog post will look at #4 and #5.