I recently experienced one of those prescription increases that makes us take notice. One of my drugs increased 200% from December 2025 to January 2026. What caused this? It didn’t take long to discover that my PBM changed. PBM is not a medical condition; it is a financial middleman called a pharmacy benefit manager.
So, I called my new PBM and asked about their price increase. After waiting for a few minutes, I was finally connected to a young man from somewhere near Bombay, India. He listened politely to my situation and said he would look into it and get back to me. I initially received an email that my drug would be handled by its vertically integrated drug company partner. A few hours later, I received an email telling me that the drug company did not have a supply of the prescribed drug. About an hour later, I received a robocall from an AI-powered agent who told me that my health plan did not cover my prescription.
So I called my insurance company and was told that my call was VERY IMPORTANT TO THEM and there was a 45-minute wait time. So, I went back to my computer work with the reminder (every 30 seconds) that my call was VERY IMPORTANT. After 50 minutes, I hung up and wrote them a letter. I haven’t gotten a response yet.
The weirdness of this adventure is that my health plan is pretty good, and until January 2026, it covered my drug.
It appears that we have epidemics all over the place. We have measles, and now there is the scourge of PBMs.
My brother recently passed on a video that captures the situation quite well.