What Are Pharmacy Benefit Managers, and How Do They Affect Your Health Care?
Industry News
Thursday, November 21 2024
(Nov 19) By Matthew Gibbs - Have you ever wondered about the journey your medication takes before it’s ready for pickup at your local pharmacy, or before it arrives at your door? It’s easy to assume the transfer is somewhat simple — that it leaves the manufacturer, travels through a distribution network, and arrives at its final destination. But the reality of the journey is much more complicated, and it’s a big reason why drug prices are increasingly unaffordable for so many patients and families.
Multiple players and processes are involved between the time a drug is produced to the moment it lands in your hands. Your doctor will prescribe a drug, your health plan will authorize its coverage, and your pharmacy will dispense the medication. These are critical and expected pieces of the puzzle. But an invisible entity you rarely interact with has much more control over the price and process than most people realize: the pharmacy benefit manager, or PBM.
These behind-the-scenes businesses play a significant role in dictating which medications you can access, how much you end up paying for them, and even which pharmacies you can use to pick up your prescriptions. Some PBMs even pressure you to use the pharmacies that they own, especially for home delivery of medications. All of that adds up to an outsized impact on your finances, your health and ultimately, how your prescription drug coverage impacts you.
In the span of a few short decades, PBMs' market power has signficantly increased and become a major obstacle to fairness and value in the pharmacy care journey. This challenge is one reason why Blue Shield of California set out to transform pharmacy care through an innovative new model designed to make medications more affordable for our members.
But what are PBMs, exactly? Let’s walk through their role in the healthcare system, how that role has evolved over the years, and the impact they have on millions of American healthcare consumers every day.
To Read More Click Here
Multiple players and processes are involved between the time a drug is produced to the moment it lands in your hands. Your doctor will prescribe a drug, your health plan will authorize its coverage, and your pharmacy will dispense the medication. These are critical and expected pieces of the puzzle. But an invisible entity you rarely interact with has much more control over the price and process than most people realize: the pharmacy benefit manager, or PBM.
These behind-the-scenes businesses play a significant role in dictating which medications you can access, how much you end up paying for them, and even which pharmacies you can use to pick up your prescriptions. Some PBMs even pressure you to use the pharmacies that they own, especially for home delivery of medications. All of that adds up to an outsized impact on your finances, your health and ultimately, how your prescription drug coverage impacts you.
In the span of a few short decades, PBMs' market power has signficantly increased and become a major obstacle to fairness and value in the pharmacy care journey. This challenge is one reason why Blue Shield of California set out to transform pharmacy care through an innovative new model designed to make medications more affordable for our members.
But what are PBMs, exactly? Let’s walk through their role in the healthcare system, how that role has evolved over the years, and the impact they have on millions of American healthcare consumers every day.
To Read More Click Here