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 that through your insurance. Well, it’s $6.”
Feeling that rush of relief? This is your pharmacy benefit manager at work.
A pharmacy benefit manager, or PBM, provides your prescription coverage. Part of this is negotiating with drug manufacturers to get you lower drug prices. Many offer a variety of services to make it easier – and more affordable – for people to get the medicines they need.
As an independent pharmacist in San Antonio, I work all the time with PBMs that provide valuable or critical services to their members. But they can also come under attack from powerful political interests that want to force patients like you to pay more for the drugs you need.
The Texas Legislature is meeting in Austin right now, and prescription spending is sure to be on the agenda. State leaders need to push back on any pressure they can get to reduce PBMs and the valuable services they provide to patients.
Here’s just one example: A PBM called IngenioRx contacted me about joining their program called ZipDrug. This program helps ensure that patients are taking their prescribed medications.
Prescription adherence is a huge problem in San Antonio and across the country. A recent study shows that medication nonadherence affects 40% to 50% of patients with chronic diseases — and causes more than 100,000 preventable deaths and $100 billion in preventable medical costs each year.
ZipDrug creates personalized services for patients, including hand delivery and custom pill packaging so they can take the right medicine at the right time. The program 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 should take it. PBM programs like ZipDrug help me help them. Since entering the program, I have seen many patients benefit from this service; They get the convenience of mail order but the friendly and individual service of a local, familiar pharmacist. This is especially important for older patients, who do not need to drive or log into an app or computer to participate.
These programs keep patients out of emergency rooms, playing an important role for communities and taxpayers. According to the Centers for Disease Control, hospital care accounts for the largest share of private health care spending—about 40%. Keeping patients out of the hospital is good for patients and their families, and it keeps health costs down.
Unfortunately, PBMs regularly come 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 pharmacy group. 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 is imperative that our leaders do not fall for it. I’ve found most of the PBMs I work with to be the best partners — they look out for patients and help us help them. And, by keeping Texans healthy and out of the emergency room, they save the state tens of millions of dollars each year.
The state should not take away one of the best tools we have to help Texas patients. When patient-centered pharmacists can work with innovators like IngenioRx and ZipDrug to create incentives for better patient care, we achieve the best outcomes for all Texans.
Patel is an independent pharmacist in San Antonio.