Physicians Vs PBMs?

I shared one of Toni’s quotes the other day and have some follow-up information that she sent me.  I will have to try and read it and share later today.  In the meantime, I saw this quote this morning from the same interview that she gave.

PBMs would love to move toward some standards that the physicians had access to.  That is the whole objective of electronic prescribing.  Every time the physician chose a drug, it would tell them if it was on formulary; if there were drug interactions; if there were coverage issues; and what the copay was.  I am not sure most physicians want this.  This would push a lot of work into their already abreviated office visits.

Additionally, I am not sure it is all the PBMs issue.  Everyone has different perspectives on cost, drug coverage, benefit design, etc.  I don’t think we will get to a common benefit design in this country that would simplify the PBM’s job.  Customization is the number one driver of cost within the PBM.  It causes huge IT issues.  It causes huge training issues.  It requires all kinds of inefficiency.

I am not sure that Toni and the PBMs are far off in what they want, but the reality of implementing it is a long way off.

“Physicians deal with too many health plans and numerous PBMs, and from our view they have no consistency. We have no way of knowing the various protocols and regulations they operate with, and new product designs make it impossible to keep up. Formularies are cumbersome and change all the time, and it is unclear who controls the formulary. It appears that formularies are based on [achieving] optimal revenue, not evidence-based. The goal should be to reduce hassles for primary care physicians and lower costs to patients and purchasers of health care. Health plans and PBMs are seen as the problem, not the solution.”

— Toni Brayer, M.D., who has practiced internal medicine in San Francisco for more than 20 years, has served as president of the S.F. Medical Society, and is chief of staff at California Pacific Medical Center, told AIS’s Drug Benefit News.