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Primary care physician relationships were once deemed the most sacred in the healthcare system. Long considered the gatekeeper of medical services, plan members built loyal, trusting relationships with these providers, who in turn acted as “quarterbacks” for their patients’ healthcare needs. Like a general contractor overseeing a large construction project, primary care physicians (PCPs) directed members to the appropriate specialists, prescription drugs and hospital systems – and followed up with their patients to ensure medical needs were being met. In fact, the entire health maintenance organization (HMO) model was predicated upon the referral discretion of the PCP; as have more recent …

… of consultants on all sides. There is no doubt that pharmacy cost transparency rules are needed and they are coming. Federal laws restrict “profits” to 15-20% of insurance premiums, but here is a relatively new game that’s being played: All of the four national health insurers own pharmacy benefits managers (PBMs) and other providers of healthcare. Owning providers allows the health insurers to expand profits in areas other than “premiums.” The federal law restricts profits on premiums but does not restrict profits on services rendered by providers owned by these insurance carriers. Axios announced days ago that the …