March 6, 2019
We continue to support President Trump’s efforts and enthusiasm to bring down healthcare prices.
Our suggestion: let’s talk about Pharmacy Benefit Mangers.
We’ve written about PBMs before, as they’re the shadowy middlemen of the healthcare system, despite appearing in the Fortune 500 (and in the top 10 in the Fortune 500).
PBMs are massive companies which are supposed to leverage their size and market share to help patients to receive discounts on prescription medicines or to streamline the healthcare system. Unfortunately, the opposite has proven true, as PBMs more frequently leverage their size to create better deals for themselves.
Last week, MedScape detailed a practice, called pre-authorization, which is slowing down treatment for cancer patients.
MedScape showed how, by refusing to cover medications until other treatments or surgeries were tried, PBMs are standing between patients and the cures their doctors recommend.
Specifically, MedScape outlined how one physician was told by a PBM that his patient with metastatic kidney cancer needed to have their kidney removed before receiving the preferred treatment prescribed by the oncologist. Even when the physician explained that the patient was not a candidate for surgery, it still took three months before the PBM would allow the patient access to the treatment.
From the piece:
It has become increasingly apparent that PBMs — who generally act as middlemen between insurers and healthcare providers — are having a major impact on cancer patients’ lives and on how oncologists deliver care…
…Prior authorization is the bane of many specialties, but in oncology, the delays can mean the difference between life or death. Turnaround times for authorizations are increasing, and the process has become more complicated, said Melissa Dillmon, MD, chair of the oncology division at the Harbin Clinic, a large multi-specialty facility in Rome, Georgia.
It’s shocking we have to say this but forcing cancer patients to delay treatment is wrong.
It’s why we oppose proposals like those to reduce protections for certain types of conditionsor the practice of forcing patients to use specialty pharmacies.
In the end, patients get hurt.
We encourage Congress and the Trump Administration to take a hard look at PBMs and these abusive practices.
For more information, read the piece on MedScape.
