PHARMACY BENEFIT MANAGERS: HELPING TO KEEP NEW YORKERS HEALTHY
Our collective will and intellects are being called upon to manage COVID-19, save lives, and restore our economy. During this public health emergency, it is crucial that every sector of our health care system step up to the challenge. America’s pharmacy benefit managers (PBMs) have a key role to play. PBMs manage prescription drug plans for hundreds of millions of Americans who have health insurance. We connect physicians, pharmacies, and payors to work together to serve patients. We also work with the rest of the drug supply chain to look ahead to mitigate shortages and maintain access to medications.
During this public health emergency, the sole focus for everyone in the prescription drug supply chain, including PBMs, pharmacists, drug manufacturers, and others in the supply chain, should be keeping Americans healthy.
As patients evaluate their prescription drug needs, PBMs are providing clinical care services and encouraging patients to consult government guidance and, as needed, their health care providers.
During the coronavirus public health emergency, PBMs are promoting the following principles for patient access to needed medications:
• PBMs, other drug supply chain stakeholders and federal, state, and local government partners should work together to sustain access to care for patients and prevent drug shortages.
• PBMs recommend multiple approaches be made available that ensure patients have access to their prescription drugs now and in the days ahead, by balancing convenient, reliable access – such as home delivery and additional supply on hand – with the potential for drug shortages.
• PBMs recommend guidance from federal, state, and local government agencies that balances patients’ need to stay at home, the clinical appropriateness of supply for any given drug, and the need to prevent future drug shortages.
While the coronavirus itself is a new public health challenge, PBMs have substantial experience helping to mitigate prescription drug access concerns during natural disasters, including floods, wildfires, hurricanes, and tornadoes. We have learned from previous regional and global health care events, such as Zika, Ebola, and the H1N1 virus.
For example, working in collaboration with the rest of the pharmaceutical supply chain, PBMs are monitoring the drug supply to detect potential shortages and spikes in prescribing that might be related to the coronavirus, and reporting them to government agencies. If there are shortages, PBMs will work to facilitate access for as many patients as possible from the existing supply.
In addition, some patients, particularly those with chronic conditions, will find home delivery well suited to help them avoid unnecessary exposure to other people. People with diabetes, heart disease, and high blood pressure may be at higher risk of complications from COVID-19. PBMs’ state-of-the-art mail-service pharmacies can provide these patients with medications that are delivered right to their doorstep, and PBM pharmacists are available by phone 24/7 to answer questions and provide guidance and support.
PBMs are helping in other ways as well. Whether patients are seen via telehealth services or in person, real-time benefit tools allow physicians and other prescribers to immediately view covered medications and the patient’s cost sharing, as well as send a prescription to the patient’s pharmacy of choice, including chain drugstores, independent pharmacies, and mail-service pharmacies. PBMs’ real-time benefit tools can help prescribers choose the most cost-effective medication and reduce out-of-pocket spending. Should some drugs be in short supply, real-time benefit tools can help prescribers and pharmacists quickly determine the right therapeutic alternative for each patient.
Our health care system – and entire nation – is being challenged in ways that seemed unimaginable just weeks ago. PBMs are deploying every available tool to help patients. We are proud of our role in this effort and remain vigilant in taking steps to help all New Yorkers stay healthy.
JC Scott is President and CEO of the Pharmaceutical Care Management Association.