There is growing awareness of the problems and pitfalls with Pharmacy Benefit Managers (PBMs) in the United States health care system. Contracted by insurance carriers to negotiate on their behalf with pharmaceutical companies, these ‘middle men’ corporations have quietly become an unavoidable part of our nation’s health care system. Controlling at least 80 percent of drug benefits for over 260 million Americans, PBMs have the power to negotiate drug costs, what drugs will be included on plan formularies, and how those drugs are dispensed. Oftentimes, patients are required to receive drugs through PBM-owned specialty pharmacies.
However, while the role PBMs play in the U.S. health care system is complex and under scrutiny by policymakers and the public, with much of the debate focusing on economics, there is often little discussion of the impact PBMs have on patients.
A young husband was diagnosed with advanced melanoma and tumors attached to his brain. Waiting on the other side of his oncology clinic’s pharmacy counter was a potentially life-prolonging drug. But his Pharmacy Benefit Manager […]
Walgreens Boots Alliance said Monday that it had reached a deal to combine its mail-order pharmacy and specialty drug business with Prime Therapeutics, which will also distribute medicines through the drugstore chain’s retail pharmacies.
Derek, a young husband, was diagnosed with advanced melanoma with brain metastases. Prognosis was grim, yet a ray of light appeared in the form of a new drug prescribed by his doctor. Proven to have […]
Bill was prescribed an oral medication that works to prevent his cancer cells from replicating, thus reducing the growth and spread of the disease. His oncologist faxed the prescription to the specialty pharmacy indicated by […]
Carol was battling metastatic colon cancer. Unable to receive the same chemotherapy Carol had been treated with initially, her oncologist prescribed a medication to help stop the cancer from spreading any further. Her physician sent […]