Imagine you go to pick up a prescription. You hear the pharmacist say something like, “That’ll be $200…oh wait, I didn’t run it through your insurance. Okay, it’s $6.”
That rush of relief you’re feeling? That’s your Pharmacy Benefit Manager at work.
Pharmacy Benefit Managers, or PBMs, provide your prescription coverage. Part of that is negotiating with drug manufacturers to get you lower prices on medicine. Many also provide a range of other services to make it simpler — and more affordable — to get the medicine people need.
As an independent pharmacist in San Antonio, I work with PBMs all the time that provide valuable or critical services to their members. But they also can come under withering attack from powerful political interests looking to force patients like you to pay more for the drugs you need.
The Texas Legislature is meeting in Austin right now, and prescription costs are sure to be on the agenda. State leaders need to push back on the pressure they’ll get to undermine PBMs and the valuable services they provide to patients.
Here’s just one example: I was approached by a PBM called IngenioRx to join a program they have called ZipDrug. The program helps ensure patients are taking their medicines as prescribed.
Adherence to prescriptions is a huge issue, in San Antonio and across the country. A recent study shows that medication nonadherence for patients with chronic diseases affects as many as 40% to 50% of patients — and causes more than 100,000 preventable deaths and $100 billion in preventable medical costs every year.
ZipDrug creates personalized services for patients, including hand delivery and custom pill packaging to help ensure they take the right medications at the right time. The program also connects participants with high-quality pharmacists in their area to help ensure their needs are being met.
As my patients’ pharmacist, I know when their medication should be refilled, and when and how they need to take it. PBM programs such as ZipDrug help me help them. Since entering into the program, I’ve seen scores of patients benefit from this service; they get the convenience of mail order but the friendly and individualized service of a local, known pharmacist. It’s especially important for elderly patients, who don’t need to drive or log in to an app or computer to participate.
These programs also keep patients out of emergency rooms, playing a vital role for communities and taxpayers. According to the Centers for Disease Control, hospital care accounts for the largest share of personal health care expenditures by far — nearly 40%. Keeping patients out of the hospital is good for patients and their families, and it keeps health costs down.
Unfortunately, PBMs regularly fall under attack from interest groups and even some government officials. It’s easy to see why: every dollar that PBMs save customers is a dollar that doesn’t go to a big drug company or a pharmacy conglomerate. Big Pharma spent $23 million on lobbying in the first nine months of 2021 alone — you can bet their lobbyists will have a big presence in Austin this spring.
It’s essential that our leaders not fall for it. I’ve found most of the PBMs I work with to be great partners — they look out for patients and help us to help them. And, by keeping Texans healthier and out of the emergency room, they save the state hundreds of millions of dollars every year.
The state must not take away one of the best tools we have to help Texas patients. When patient-focused pharmacists can work with innovators like IngenioRx and ZipDrug to create incentives for taking better care of patients, we achieve the best outcome for all Texans.
Patel is an independent pharmacist in San Antonio.
