Several questions thus far have touched on negotiating power as a core principle to reduce drug prices. Through my work with the State and CMMI this year, I have been exposed to the countless ways we are regulating physicians and hospitals. While these are far from perfect, it is clear our government and insurers have taken a strong interest in controlling prices and utilization on the hospital-doctor level. What I don't understand is why the government, insurers, and others in the position to regulate prices have not taken a stronger interest in the other side of the equation: everything that happens in the supply chain before the drug ever reaches a hospital. We are placing full trust in PBMs and GPOs' ability to negotiate the best deals for insurers, I think because insurance companies and payers bear risk- (so of course they would work to get the lowest prices, right)? However, the basis under which these intermediaries negotiate lower prices is unclear & not closely followed. Do you think shining light on the negotiations of GPOs, PBMs, wholesale distributors, etc. to the degree we regulate doctors would help control prices and improve access?
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