I posted my thoughts about pharmacy / PBM communications with MDs on Kevin MD’s Blog and generally got comments from physicians that didn’t like PBMs. This is just a few of the physicians in the US, but let’s just play this out.
If there were no PBMs (and let’s assume that meant no pharmacy benefit) in the US, what would the pharmacy business look like?
- A cash business (no copays) with high variance between stores on what consumer’s pay for their medications.
- No centralized database for sharing prescription data across pharmacies and avoiding drug-drug interactions.
- No 90-day prescriptions (retail or mail order) since retailers would certainly rather have foot traffic.
- No formularies so patients would have no framework for making cost / clinical tradeoffs.
- No utilization management programs (prior authorization, step therapy, quantity level limits) so people would unnecessarily use higher cost drugs.
- A much higher mix of brand drugs than there is today since the primary source of information to patients and physicians about drugs would be from the manufacturers.
- Independent pharmacies would still be losing business due to chain drug store strength.
I don’t disagree that there are issues and the system isn’t perfect, BUT the PBMs save money and play a critical role. Without them, we would have a pharmacy system with other issues, higher costs, more clinical issues, and less convenience. Isn’t that worth a few faxes from the PBM?