By Dr. Michael Crowe
My job as a pharmacist is to help patients get and stay healthy using prescription and over-the-counter medications, providing guidance and advice along the way.
The way the process should work: A doctor prescribes a medication, and, after ensuring it is appropriate, we dispense it. Sadly, the way it works too often is that a pharmacy benefit manager (PBM) gets between patients and lifesaving medication.
Currently there’s a speed bump impacting the way patients access medications that are key to keeping their lives in balance. You may have heard of “prior authorization” or “step therapy” — these are examples of how PBMs can get in the way, delaying access to treatment or preventing it altogether.
Michigan has taken a step to speed up this system. A piece of legislation that was just signed into law will streamline the prior authorization process by standardizing it and reforming it into an electronic process. Additionally, the bill also would provide certain criteria and procedures for prior authorization determinations and appeals, provide time limits and require insurers and the Department of Insurance and Financial Services to make and publish certain reports.
PBMs were created to help manage prescription drug costs and benefits overall. Over the years, however, many PBMs have diverted potential prescription savings into profits for their own companies — costing patients more rather than saving them money.
The PBM industry originally existed to help manage prescription drug costs and benefits overall.
But most have ventured far from their original destination.
PBMs are now diverting potential prescription drug savings into the highest rates of profit in the prescription drug supply chain. Three major PBM companies make up 75% of the market, and have become so profitable over time, they are among the Fortune 25 companies — ranked higher than the drug manufacturers whose prices they had promised to control.
I work with patients every day to find a way to bring the price of their prescription down, prescriptions that aren’t a choice but are the only way to control a condition destroying an individual’s body or mind.
Unjust PBM practices manipulate drug prices and out-of-pocket costs and undermine the possibility for competition that would drive value and savings for consumers. PBMs focused only on their bottom line leave no room for the patients they supposedly serve.
In Michigan, we are fortunate to have reined in the middlemen through the hard work of the Michigan Pharmacists Association and the Michigan Legislature. Both sides of the aisle have made it clear that they are done with the unfair practices of PBMs, and in February, Gov. Gretchen Whitmer signed legislation into law that provides reasonable protection and recourse against the unjust and outrageous tactics employed by PBMs.
Michigan has been able to get these middlemen under control, and it is time for Congress to step up and do the same.
My request as a pharmacist is this: Congress, rein in the middleman. As long as PBMs are able to continue operating unfairly, patient access to care will suffer. It’s time to shed some light on these companies and their tactics which gouge the American taxpayer.
Dr. Michael Crowe is president of the Michigan Pharmacists Association.