To the healthcare workers (mostly medical workers), do you find that Third-Party Administrators (TPAs) and Clinical Management Organizations (CMOs) are problematic or necessary parts of the healthcare system? Excuse my ignorance if this is a dumb question, but I am a pharmacy student and wanted to see if there were parallels to our issues with Pharmacy Benefit Managers (PBMs).
Currently, several state and national pharmacy advocate organizations are lobbying/calling for PBM reform (a losing battle fighting against PBM lobbyist money). The problem I think most pharmacists have is that the PBM used to be a necessary part of the system (a bridge between manufacturers and pharmacies), but the necessity of this role has greatly waned. This makes it super unclear what their role is, and it doesn't help that they have little to no disclosure of their fees or what services they provide. All we know is that they play a large role in the artificial inflation of drug prices and set the dwindling reimbursement rates that make it very difficult for pharmacies to stay profitable (Pharmacists, correct me if I'm wrong).
I was wondering if TPAs and CMOs, being sort of analogous to PBMs, share some of the same issues and distrust, or if their role is different enough in the medical field that they are seen as trusted/important. Are they also culpable in ballooning medical costs?
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