PBMs Are "Practicing Medicine," Community Pharmacists Charge...

Pharmacy Times, Volume 0, 0

Pharmacy benefit managers (PBMs)"have evolved from their original roleof claims processors into the unauthorizedpractice of medicine and pharmacy,"a National Community PharmacistsAssociation (NCPA) officialcharged in a stern warning to Washingtonpolicy makers, who are beinglobbied heavily by representatives ofthe PBM industry.

"PBMs dictate what medication thepatient may have, based on specialpayments the PBM receives, not onthe basis of the patient's health status,"NCPA Government Affairs VicePresident John Rector said.

Rector's concerns about PBM practicesare shared by a large number ofindependent pharmacy owners acrossthe country. During a recent NCPAgovernment affairs conference inWashington, DC, the conduct of PBMsemerged as the top complaint amongthe pharmacists in attendance.

Although PBMs justify many oftheir practices as necessary for holdingdown the cost of drugs, NCPA officialscontend that these "middlemen" actuallydrive up the cost of medicine."Despite PBM claims of reducing thecost of prescription benefits, priceshave increased more than 16.8% in1998, 14.2% in 1999, 16.3% in 2000,16.9% in 2001, 18.4% in 2002, 19.5%in 2003, and an estimated 18.1% for2004," Rector said.