So, you know, it goes to manufacture, GPO, doctor, me.
So, we only have four steps instead of 12.
And it results in really phenomenal savings.
So, I think there are opportunities
to look at more direct routes
to acquire those medications.
And, you know, the problem with that at this point
is depending on the flexibility
and willingness of your employer
is those don't get applied to your maximum amount
of pocket or deductible.
And, I mean, some of them, it's like $1.80 from my doctor.
So, it's like, okay, how much does that really change
the scenario?
Well, for me, it's not gonna change it a lot.
But, you know, every little bit does help.
And I think it's reasonable for, you know,
that to be something either I take on potentially
because it is so low and maybe the exchange is that
instead of covering generics,
because those should be very cheap to acquire
the plan covers higher cost medications, maybe.
How that would work, I don't, you know,
like that could be a very reasonable step.
But, you know, that might be unpopular in cost money.
So, but yeah, so there's, so basically it's a,
it's a cost plus model.
So, it's a direct purchase and then inner plus certain fees
and usually very inexpensive.
I swear, I'm almost done.
Yeah, that's okay.
Pete, you've mentioned that there are three PVMs
that run 80% of the market.
Yep.
But as you've talked about, basically,
the more steps you add, the more complex things get.
So, is this consolidation of PVMs in the middle
a big part of the problem?
Or is the problem, the entire system has just had too many?
Well, okay, so I love that question
because it highlights another significant problem
with the market today.
So, you might expect in normal economics for, say,
three big players to control 80%,
but then they have a bunch of other folks
that are coming to them, right?
And saying we're gonna buy this
and we're gonna create competition
further down the supply line.
What's happened with these really mega companies
is what they are.
I mean, we call banks too big to fail at one point
and these are probably too big.
I call them too big to regulate.
So, what you have is they have added extra steps.
So, for example, in the late 2010s,
so 2019, 2020, PVMs decided that they wanted to incorporate
two of the three incorporated in Europe.
One is in Switzerland and one is in Ireland
and then one is here in the U.S.
They created what are called group purchasing organizations.
So, very large group purchasing organizations.
They testified,