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Can a collaborative attack by US health plan sponsors, policymakers and patients against Pharmacy Benefit Managers (PBMs) improve patient adherence?

By Anonymous on Jul 26, 2012

We all know non-adherence is expensive. The latest figures from the National Consumers League estimates the cost at $290 billion a year, with the obvious side effects being more doctor visits, more illness and more patient sickness.

‘Who Runs My Drug Plan?’, a new website featuring a comical video and some info on how to get the best value from your prescription drugs, aims to get rid of some of these problems.  Within the website, patients are educated about the alleged role of PBMs. According to the site, these pharmaceutical ‘middlemen’ tell physicians what drugs they can prescribe and force patients to receive medication from a very small number of pharmacies under an employer health plan or government benefit. In many cases, patients are prevented from filling out a prescription form at a local pharmacy of their choice due to higher out-of-pocket costs and so pay for medication which they do not understand and will not use.

Although this website highlights the importance of collaboration in healthcare reform, the only recommended action that a patient can take, at the moment, is to write a letter to their policymaker or a newspaper editor alerting them of this issue.  Achieving changes in policy in each state takes time even if a piece of legislation like the Pharmacy Competition and Consumer Choice Act 2011 already exists to champion patient choice.  The only other recommended way of achieving reform seems to be through health plan sponsors who can follow a 10 point plan to ensure better patient care if they wish. So it seems that the patient can take charge of their healthcare future but it will be a long road to bring a meaningful change.

Although the website does not signal any chance of immediate action, it can inspire a change in thinking. The video is effective as it keeps the message simple for patients and employers who do not understand the intricacies of their healthcare system. Patients can now challenge their employer about their healthcare packages and can be encouraged to keep their local pharmacy in business, improving their adherence for a particular treatment while reducing medication costs. The website has a useful resources section which displays information from other organisations like Fight4Rx, who have approved local pharmacies who they believe will give reliable treatment advice to patients with their pharmacy locator.   

In addition, this website could instigate another patient-centred campaign. Very often, doctors and pharmacists have been told to communicate better with patients. But what if a campaign was created to encourage patients to take charge of this communication? A 2008 survey stated that although doctors realised the importance of prescribing drugs to reduce patient co-payments, many were not aware of the list price of the medication or the patient co-payment amounts. This survey indicates that even if doctors are aware that they do not have enough information on the prescription process, they will not always actively improve their knowledge in order have a valuable conversation with the patient.

Doctors have always been relied on for delivering patient-centred care; they are constantly being affected by other healthcare burdens and do are not always able to offer the best solution for an individual patient. A 2005 Archives of Internal Medicine study showed that insufficient time is a major reason for stunting communication in a doctor-patient relationship. Patients should now be more proactive about their healthcare and should write down questions that they hope to ask a doctor or a pharmacist in consultation concerning side effects, cost or when they should take the medication. The Script Your Future campaign currently aims to improve patient confidence in asking questions about their medication although it does not seem to have a wide consumer base just yet.  

Patients need to be empowered to seek the best treatment whether this is by affecting policy or simply encouraging better communication with their doctor or pharmacist. This new website demonstrates that patients should never take any healthcare decisions at face value and should not be afraid to challenge it. The success of this website still needs to be seen and so a long-lasting solution for reduced prescription spending and more patient choice is still lacking. Therefore, it is very important that doctors, pharmacists and patients still work together in order to prevent the US healthcare system from wasting even more money due to non-adherence.

Perhaps, it is patients, rather than healthcare professionals, who should be assisted in taking the first step to improve this relationship. Additionally, pharmaceutical company employees could ensure that any prices are reflective of patient needs and expectations and not to fill any unnecessary pockets. After all, it is patients who will keep them in business in the future and not middlemen.