PBMs: Improving Patients’ Pharmacy Experience and Health Outcomes
This week, PCMA launched an important new ad campaign, “The Patient Journey.” It calls attention to the work pharmacy benefit managers, PBMs, do to produce a seamless experience at the pharmacy counter for patients, while also working to improve overall health outcomes.
Every year, literally billions of prescriptions are filled in retail pharmacies that patients rely on to lead healthier lives. To make that possible, PBMs bring together health data from across the provider spectrum through advanced technology and expertise. What often seems like a straightforward, simple transaction is the result of analyzing and processing patient health data and connecting different parts of the health care system.
For example, the moment a physician prescribes a drug, PBMs check the patient’s pharmacy benefit coverage information, transmit the patient’s cost sharing options to the patient and physician, and examine the medication in connection with the patient’s health history to help avoid possible harmful drug interactions. When the patient reaches the pharmacy counter, the process is instantaneous thanks to the PBM connecting the physician, pharmacy, health plan and patient in real time. Once the patient has their prescription, whether it be PBM pharmacists and nurses contacting patients, a wearable device or an app on a phone that monitors if patients have taken their medications, PBMs are providing the necessary support to help patients stay on their medications.
The result of this work is only apparent to patients when they receive their prescription, whether it’s by mail or in person. I think of my own family’s patient journey as my father battled esophageal cancer and then dementia, relying on a host of treatments to manage his conditions. As his needs changed, as his prescriptions changed, he was able to get the medications he needed when he needed them. And we, his family caregivers, didn’t have to think about all the work going on behind the scenes to deliver his treatment. We could focus on him, his well-being, and our time together.
The health care system has a shared goal with respect to prescription drugs: better patient care. When patients have access to the medications they need and are enabled to stay on their medications, that leads to better health outcomes.
PBMs are widely recognized for negotiating directly with pharmaceutical companies to lower drug costs, and while we are proud of that vitally important work, there is more to the PBM story. Through expertise, data, and technology, PBMs pave the way for a seamless pharmacy experience helping patients to get and stay on their medications and through the process, lead healthier lives.