Pharmacy benefit managers ease seniors’ drug costs

A photo illustration of drug costs, with prescription medication atop a dollar bill. (Image: Video_Creative)

The Golden Years for senior citizens across the Golden State are longer and more active than for the generations that preceded us. This is a real gift, but it does mean most of us are battling age-related medical conditions, often dealing with them for decades.

Prescription drugs are a big part of our healthcare toolbox, and today, almost 40 percent of senior citizens use five or more medications.

This can get very expensive. Pharmaceutical manufacturers are charging ever-more outrageous prices for their products, and the trend is not restricted to innovative treatments. Whereas research and development might help to explain the six-figure price tag of new hepatitis C cures, it’s difficult to understand why insulins — diabetes treatments in use for nearly 100 years — more than tripled in price from 2003 to 2013 and then kept going up. Similar price hikes have been imposed on medicines used to treat everything from heart disease to acid reflux to rheumatoid arthritis. Even generic drugs are affected.

The potential for harm from taking the wrong medication is especially high for seniors, so the added protection is welcome.

What a lot of people don’t know is that many seniors are being protected from the gravest impacts of Big Pharma’s excesses by little known players in the healthcare market, pharmacy benefits managers, also known as PBMs.

These companies work on behalf of senior citizens, employers and their workers, unions and their members, and other groups to control prescription drug costs. Those benefitting from PBMs’ efforts include older Americans who rely on Medicare Part D prescription drug coverage and Medicare Advantage health plans.

Pharmacy benefits managers deliver an average savings of $941 per consumer and, given seniors’ greater reliance on prescription drugs, probably much more for the majority of us. In fact, pharmacy benefits managers will save nearly $900 billion for Medicare Part D alone over the next decade. Without PBMs, premiums for the program would be about 66 percent higher.

Pharmacy benefits managers also supply other advantages. Many seniors enjoy the convenience of mail-order prescription refills, and they can be absolutely essential for home-bound individuals, those who lack transportation, and the medically frail. This service is provided by pharmacy benefits managers.

Then there is safety. Tricare, the health system used by many veterans and their spouses, audited its PBM-run mail-order pharmacy program and found an accuracy rate of 99.9997%. The potential for harm from taking the wrong medication is especially high for seniors, so the added protection is welcome.

Recent innovations are also improving the prescribing process. With new “point of prescribing” transparency tools, we’re likely to see increased coordination and better delivery of care between providers and what’s covered under a patient’s health insurance plan. The technologies provide real-time cost information specific to patients, along with other data about the efficacy and safety of prescriptions. That way, doctors, pharmacists, and patients have the full picture as they seek a medication that can deliver the best health outcome for the patient’s prescription drug dollar.

The U.S. needs to make its healthcare spending more sustainable, and that means tackling the problem of prescription drug pricing. So far, incredible lobbying investment from the pharmaceutical industry has largely protected them from bearing responsibility for rising drug costsandallowed them to scapegoat others.

Unfortunately, pharmaceuticals aren’t like automobiles or hair conditioner. Seniors can’t just shop for a different brand. We’realways going to need allies who can help us and our doctors find the highest value treatments, those that deliver the best results at the most reasonable cost. Pharmacy benefits managers have been there for seniors for years, and elected officials should remember that when pharmaceutical manufacturers point fingers at everyone but themselves for skyrocketing prescription drug costs.

Ed’s Note: Gary Passmore is President of the Congress of California Seniors, a statewide nonprofit advocacy organization focused on legislative and consumer issues that impact older adults.


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