In the world of healthcare, pharmacy benefit managers are no better than the playground bullies that try to take your lunch money.
Forced mail order is a perfect example. Recently PUTT has begun receiving copies of "choice requirement" emails and mailings from our members that read like a low budget suspense novel. Patient walks into their pharmacy to fill their long-term prescription, days later they receive notice from their insurance carrier's PBM that they will be required to pay the full price of the medication going forward if they don't transfer the prescription to mail order service. (cue the scary music)
Privacy rights notwithstanding, steering tactics like this one create a horrible situation where entire families and communities pay the price. It's a prime example of how PBMs care only about their bottom line, not the patients, and certainly not that patient's community. Never mind that this patient may require special assistance from their local pharmacist who knows their medical history & watches for drug interactions between their medications. Never mind that mail order medication is usually shipped to the patient from a distance and can easily be rendered ineffective in treating that patient's condition due to a lack of temperature control during transit, which could cause them to become far sicker than before.
Medicaid Programs Willing to Boot Out Drug Pricing Middlemen
Axios, October 8, 2019
Michigan's Medicaid program is proposing to fire the pharmacy benefit managers that handle its prescription drug claims and negotiate prices. The state would manage drug coverage itself, starting Dec. 1.
The big picture: More state Medicaid agencies have determined that outsourcing all negotiations and operations of prescription drugs to PBMs has not produced the dramatic savings they were promised.
Details: Michigan officials said in a bulletin the state could extract bigger rebates from pharmaceutical companies and cut administrative costs if the state handled all Medicaid medication benefits, instead of the current private contractors.
Between the lines: State governments, along with pharmacists, continue to lead the crusadesagainst PBMs.