Pharmacy benefit managers, or PBMs as they’re commonly known, are often the target of misguided attacks in the healthcare (pharmacy) industry – particularly from big drug companies that would profit if PBMs were less effective. This year, we are seeing renewed anti-PBM efforts in the 2022 Florida legislative session that would result in raising prescription drug costs for Florida employers, patients, and taxpayers.
Throughout my 38 years in pharmacy, I have seen firsthand how the healthcare system and programs have evolved – between the insurance companies, manufacturers, and pharmacies. When I started my career in pharmacy, insurance companies were a new frontier and for the first time ever, insurance and drug cards became available to patients. At the time, insurance companies did not cover drug costs, so I worked directly with drug manufacturers to order the supplies my pharmacy needed. Insurance companies then entered the drug market by way of selling products, such as wheelchairs, and hospital beds to brick and mortar pharmacies such as mine.
When new products came into the industry that is when PBMs stepped in – to help coordinate between the insurance company, manufacturer, and the pharmacy owner. As drug manufacturers and insurance companies expanded their operations and offerings, PBMs played a crucial role. They coordinated between complex stakeholders – the insurance company, manufacturer, and the pharmacy owner – stakeholders who were trying to balance the priorities of the patient and their own business. As the industry has evolved, the beneficial role PBMs play for both patients and pharmacists has continued to grow.
PBMS ADVANTAGE FOR PHARMACIES
PBMs are uniquely positioned because they have access to critical information by way of the stakeholders they are interacting with – in my case, insurance companies and manufacturers. They could collect data by region and help pharmacists like myself make business decisions on programs for my patients. For example, they could provide data that would tell me that my community had the highest diabetic population in North Florida. That information would allow me to explore ideas and programs that would be a real benefit to my patients.
PBM PATIENT CARE
PBMs prevent cost increases for employers and patients by negotiating against the big drug companies, But, over the years, PBMs have also taken on an increased responsibility with individual patient care. Whether they send medication reminders or make house visits or check-in calls – PBMs help identify the best way to access specialized treatments for patients with chronic conditions and seniors. For many patients with complicated medication regimens, PBMs help manage the patient’s day-to-day needs to avoid potential complications.
It is not unusual for elderly patients or those with chronic conditions to see multiple doctors at a time. Through PBMs’ patient care role, they are able to ensure that medication compliance is being met between the multiple doctors the patient is seeing. This ensures one doctor isn’t prescribing the same medication as the other or that the patient isn’t being over prescribed.
As a daughter – I saw first-hand how PBMs have taken on a significant role with patient care. When both my parents were well over the age of 65 they had regular check-in calls with their PBMs to ensure that their medications were accurate, that they were not taking duplicates of any medication, and that they were not experiencing adverse side effects, along with other questions about their healthcare regimen. Their conversations were thorough, and the PBMs were asking the right questions and were genuine in their care.
My parents’ situation was a special case because as a retired pharmacist I was familiar with their medications and healthcare regimen and was able to step in as their primary caretaker, but this is certainly not everyone’s case. Not all who are chronically ill or elderly have a family member or friend who is able to care for them.
As a pharmacist and as a daughter, I valued PBMs’ expertise. They are a voice that can speak on behalf of pharmacists to manufacturers and insurance companies while also working to help patients like my parents. If PBMs are made less effective, their ability to lower costs and expand access would be lost. Patient care would suffer, especially for those who need it most.
We all know that prescription drug costs must be lowered, but undermining PBMs will hurt, not help, these efforts. In fact a report last year by the state Agency for Health Care Administration showed that previously proposed changes to PBMs would not have reduce prescription drug costs as its advocates were claiming. As a retired pharmacist, I would encourage lawmakers to look at the industry as a whole and the benefits PBMs bring to the system and deprioritize legislative efforts targeting PBMs. We must find ways to reduce Floridians’ prescription drug costs without hindering patient care.
Lynn Massey is a former independent pharmacist and corporate pharmacist who began her career in 1979, owned a small independent pharmacy in Quincy, Florida for 32 years and retired as a corporate pharmacist in 2017.