Just about anybody in this country who has health insurance has a prescription drug benefit as part of their insurance. If you have a prescription drug benefit as part of your plan, then you have a PBM helping you manage that.
President and Chief Executive Officer, Pharmaceutical Care Management Association
We have all experienced the coronavirus pandemic together over the past year, from the panic and uncertainty of the first few months to the hope and optimism of the current vaccine rollout.
What we haven’t heard much about is how the Pharmaceutical Care Management Association (PCMA) worked behind the scenes through it all to help ensure that the prescription drug supply and payment chain continued to function well throughout the pandemic.
“We saw it as a natural position for PCMA because we are at the center of the supply and payment chain,” said JC Scott, president and CEO of PCMA.
PCMA is a trade association based in Washington, D.C., that represents pharmacy benefit managers around the country.
Also known as PBMs, pharmacy benefit managers administer prescription drug plans for more than 266 million Americans who have health insurance from a variety of sponsors including commercial health plans, self-insured employer plans, union plans, Medicare Part D plans and many others.
PBMs have an established record of advocating for, and working on behalf of, patients by negotiating directly with drug manufacturers and pharmacies.
PCMA leads the effort in promoting PBMs, which are recognized by consumers, employers and policymakers as key drivers in lowering prescription drug costs and increasing access to medications.
PBMs are projected to save employers, unions, government programs and patients $1 trillion this decade. That equates to an average of $962 per patient, per year.
“Just about anybody in this country who has health insurance has a prescription drug benefit as part of their insurance,” said Scott. “If you have a prescription drug benefit as part of your plan, then you have a PBM helping you manage that.”
Sharing a personal anecdote about how helpful PBMs can be, Scott explained how his father had been in a long-term care facility at the end of his life and required frequent adjustments to his medications.
“Every time those adjustments were made for my dad, those medications were available either at the on-site pharmacy or they were shipped in,” Scott said. “I knew that the PBM was there doing all of that work to make his care affordable and seamless during that period of his life. It allowed us to be caregivers and really focus on his well-being.”
Shoring up the supply chain
When the coronavirus outbreak gripped the globe in the early part of 2020, PCMA acted quickly in embracing existing relationships it had across the pharmaceutical industry.
PCMA partnered with a long list of associations in the drug supply and payment chain including those representing drug manufacturers, health insurance payers and pharmacies.
“We were worried there could be drug shortages due to disruptions in the manufacturing pipeline,” Scott said.
The coalition worked to ensure that existing medications that could potentially be used to help treat symptoms of COVID-19 remained available, while PBMs helped promote mail-service pharmacies.
Some of those medications, including asthma inhalers, were already critical for many patients so it was important that they remained available to everyone, not just COVID-19 patients. Once drugs were identified as being in shortage, PBMs worked diligently to ensure that existing chronic care patients had a continuous supply of those needed medications.
“We don’t always see eye to eye with the other groups when it comes to drug costs, but when it came to the question of supply chain integrity everybody worked together really well,” said Scott. “Many of those shortage fears that we worried about didn’t end up manifesting, I think in large part thanks to the supply chain pulling together.”
Helping with the COVID vaccine
As the COVID-19 vaccine eventually became available to the general public, PCMA partnered to launch a nationwide awareness campaign, promoting the vaccines as safe and effective and helping patients better understand how, and when, they could get their shots.
“Our companies have taken steps to actually identify and call people who need outreach on their eligibility or whether they need to get their second shot,” Scott said.
While the vaccine is free for Americans who want it, pharmacies and other entities that administer the shots still get paid for their work.
PCMA’s member companies provided back office support to help put that whole system together, and it worked with patients who had billing questions of their own.
“In places where patients are experiencing problems where they may be erroneously charged a fee or some other kind of cost-sharing, we are getting involved on the spot to troubleshoot that and make sure it’s fixed,” Scott said. “Patients shouldn’t be paying out of pocket the way the system is set up.”
