Novak: Pharmacy benefit manager system needs major reform

Many of us grew up with the comfort of knowing that there was a neighborhood pharmacy just a short distance from home. Unfortunately, we’re now looking at more and more areas that could be considered pharmacy deserts. A recent Delaware headline tells the story: “At least 11 pharmacies announced closures since October.”

While there have been a variety of causes cited for our loss of neighborhood pharmacies, most agree that a key factor is the unreasonable and strict tactics used by pharmacy benefit managers.

These have been around in one form or another since 1958 — and may have provided needed services in the past — but over the years, the program has consolidated power and influence, while reducing transparency and creating a “black-box” system, in which no one knows what the true value of a medication or treatment might be.

PBMs control virtually every aspect of patients’ access to medication, including premiums, out-of-pocket costs and choice of pharmacy. They insert themselves between a patient and their doctor’s choice of treatment. Additionally, they manipulate medications’ costs to best serve their profit margins. Yes, you read that right — pharmacy benefit managers will favor higher-cost medications because it will allow them to obtain higher rebates for that drug and avoid placing lower-cost medications on a drug formulary, even when a manufacturer makes it available. Essentially, this is like wanting to buy a car with the options of your choice but having the dealership make you buy another model based on the money it would make.

While everyone in the health care industry appears to be aware of the ongoing problems surrounding these managers and the need for reform, and while there are multiple pieces of legislation at both the state and federal levels designed to address these issues, we’re still waiting for definitive action that will reform this system and, hopefully, create patient choice and a healthier community.

I would be remiss if I did not point out that our congressional delegation, Sens. Tom Carper and Chris Coons and Rep. Lisa Blunt Rochester, all D-Del., have been active in leading the charge to push for PBM reform. I would encourage everyone to thank them for their efforts.

Gail Novak

President, Brandywine Valley Hemophilia Foundation

Middletown

Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.