The following is a response from my Florida Senator, Ashley Moody, regarding my concern about the proposed healthcare cuts. I think the following is a candidate for Agentic, replacing the PBMs. Please comment.
During my time as Attorney General, I saw that the practices of pharmacy benefit managers (PBMs), which act as intermediaries between pharmacies, drug manufacturers, health insurance plans, and consumers, were contributing to skyrocketing costs of prescription drugs. I took action to address the harmful practices of PBMs and advocated for stronger PBM oversight and regulation
I expect that very good liability insurance would be necessary for providing medical benefits (including potential substitution of medications) via an AI agent.
PBMs are complex businesses. Together, the three largest cover prescription drug benefits of some 250 million Americans. They use this as leverage to negotiate prices on both ends of their pipeline, as all middleman businesses do. The spread in price between what they can buy for from the pharmas and sell for to the insurance companies and Medicare is one of the so called ‘harmful practices’ alluded to. This is in part because PBMs consider their margins competitive proprietary and neither share information about it themselves nor allow pharmas or pharmacies to share information about it.
AI may indeed have a role to play in healthcare cost reduction, but wholesale replacement of PBMs, to me, is neither an easy nor an obvious one.