Are Pharmacy Benefit Managers Putting Personal Profits Ahead of Patient Access?

October 9, 2018

In the latest ASCO in Action Podcast, Dr. Ray Page, DO, PhD, FACOI joins ASCO CEO Dr. Clifford A. Hudis to discuss the impact that Pharmacy Benefit Managers (PBMs) are having on cancer care delivery and ASCO’s recent position statement on PBMs.

In its simplest form, a PBM is a middle-man company that was originally utilized by payers as a third-party manager for prescription drug claims, says Dr. Page, chair of ASCO’s Clinical Practice Committee. This largely developed out of the Medicare Modernization Act of 2003, and when Medicare Part D for oral drugs was implemented in 2006.

While Dr. Page believes that the original intent of the PBM system was good, over time that has changed.  “They claim that they’re controllers of cost,” he says, “but in reality, they have created huge and extremely complex business relationships to where they now have put personal profits ahead of patients.”

Currently, 60% of prescriptions written for cancer patients at his oncology practice have to be filled outside of the cancer center due to PBMs, according to Dr. Page.  This is a detriment to patients, as most cancer centers with in-house pharmacies are able to provide additional resources, such as medication education and financial assistance, that PBMs do not provide.

Dr. Page and Dr. Hudis also discussed ASCO’s recently released position statement which warns that some of the practices used by PBM companies could hinder patient access to timely, high-quality cancer care. In the statement, ASCO describes a range of PBM practices that, while they may be intended to help control costs in cancer care, might compromise physicians’ ability to provide the right treatment at the right time for people with cancer; place cancer patients at risk of serious complications due to drug dispensing errors; or drive up out-of-pocket costs for patients.

Listen to the full discussion here, or subscribe through iTunes and Google Play.