A Forbes contributor shares his experiences from the frontlines.
The debate over the value of pharmacy benefit managers (PBMs) can often be a little abstract. The government, health insurance companies, pharmacies and other players in the prescription drug supply chain sound off on difficult-to-understand secretive contracts, opaque rebates and mega-mergers that have allowed PBMs to grow in power.
But here’s a real-life example of how PBMs’ influence affects you and your doctor. In a recent article, Forbes contributor Dr. Gary Price shares his perspective on PBMs.
In the piece, Dr. Price details the barriers he faced prescribing a common, inexpensive, generic pain medication to one of his patients post-surgery. After facing delays applying for pre-approval (a process usually reserved for high-cost drugs), the PBM denied coverage and, to the surprise of Dr. Price, required him to prescribe a higher-cost brand drug. The copay alone of the brand drug was higher than the cost of the generic drug.
What’s at work here? Likely the influence of PBM rebates. In short: if a drug manufacturer offers a PBM a high rebate on a brand drug, a PBM will likely give the drug preferred placement on its formulary — even over cheaper, generic versions of the same drug.
Hours, days or even weeks of delay due to prior authorizations and pre-approvals, preference given to brand drugs when more affordable generics would work… these are just some of the barriers to accessible and affordable medication that we at Blink are working to break down. Why? So that physicians like Dr. Price can prescribe the right medications for each patient, and so patients can afford them.
Blink Health is not insurance. The discount prescription drug provider is Blink Health Administration, LLC, 536 Broadway, 2nd Floor, New York, NY 10012, (844) 366–2211, www.blinkhealth.com