Cost of COVID-19: PBMs Advocate for Increased Access to Meds as COVID-19 Rages On

April 27, 2020

For certain populations in America, access to quality health care and related services is a challenge. But during a pandemic like we’re experiencing with COVID-19, it can be nearly impossible.

Fortunately for those Americans and others, there is a group taking action and advocating for reliable, convenient access to prescription drugs. Pharmacy benefit managers, also known as PBMs, have taken steps and made a series of recommendations aimed at helping patients stay home, stay safe, and stay in compliance with drug directives.    

If you aren’t familiar with PBMs, you should know that their job is to help keep the costs of prescription drugs down by negotiating prices on behalf of patients. They also determine formularies, or the drugs that a plan will cover and the drugs they will not.

Whether it’s covered or not, what happens when patients don’t remain in compliance with the drugs they need? In some cases, they die.

To help facilitate access to our nation’s nearly 70,000 retail pharmacies, PBMs are providing information to RxOpen to help promote consistent supply-chain information to stakeholders. RxOpen is a central hub that allows users to search for pharmacies that are operational despite the ongoing crisis.

While that information is good to know, there’s still bound to be a segment of people who are simply unable to visit a pharmacy at this time. To help combat that, PBMs are providing home delivery of prescriptions at no additional cost and allowing pharmacies to serve their regular patients through delivery.

By loosening these restrictions, PBMs are enabling patients — particularly immunosuppressed and elderly patients, those who are more likely to feel the effects of COVID-19 — to avoid what could be a crowded retail establishment.

In another move to limit contact between potential carriers of the virus and healthy individuals, PBMs are recommending that states temporarily waive proof-of-receipt and signature delivery requirements. And, to help pharmacies focus solely on providing exceptional patient care, PBMs have agreed to limit the number of pharmacy audits unless required by law or as a result of specific fraud, waste, and abuse investigations.

Thankfully, PBMs aren’t in this fight alone.

Many PBMs have committed to increased collaboration with other pivotal participants in the drug supply chain, like manufacturers, pharmacies, hospitals, and health plans to partner on eluding drug shortages. Should a drug shortage occur, the PBM will work with the patient, the prescriber, and the health plan to find a substitute therapeutic.

Other groups like the National Association of Chain Drug Stores, National Community Pharmacists Associations, and the National Alliance of State Pharmacy Associations have similarly encouraged governing bodies to allow pharmacies workflow flexibility that can help patients.

In addition to a heightened focus on initiatives connected to COVID-19, PBMs continue to serve employer, health plan, and government clients by helping to prevent fraud, waste, and abuse, and not neglecting other public health concerns like the opioid crisis.

Have the sky-high costs of healthcare in our state impacted you and/or your family’s lives? Do you want to do something about it? Join the Coalition now to receive updates about new legislation and policies that will affect YOUR healthcare. ​Sign up now!


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