By Devin Stone
PBMs have always seemed willing to spend a few dollars here and there to protect their bottom line, so it’s of no surprise to see the publication of a staunchly pro-PBM survey by Ayers, McHenry & Associates—a group that lists the Pharmaceutical Care Management Association as one of its clients.
PBM transparency is a feature of both the House and Senate versions of health care reform, and not too long ago U.S. Rep. Stephen Lynch (D-Mass.) proposed a bill that would greatly benefit patients and taxpayers alike by forcing PBMs to stop many of their questionable business practices in the Federal Employees Health Benefits Program (FEHBP).
I cannot comment on the specifics of the PBM survey because I do not know the questions that were asked to respondents, or how exactly they chose their sample, etc. But I think it’s a pretty safe bet that none of the following questions were included:
- “As someone who pays a monthly premium to be covered under the FEHBP, in your opinion, should you have the right to receive a monthly explanation of benefits demonstrating how your money was spent?”
- “It isn’t uncommon for the pharmacy benefit managers that administer benefits for the FEHBP to limit which drugs patients are allowed to purchase. Given the rationing that is practiced, do you believe these companies should be required to report to the Office of Personnel Management the money they receive from pharmaceutical manufacturers that may influence their decisions?”
- “Do you feel that prescription drug costs are about right, too low or too high in the FEHBP?”
- “The FEHBP currently pays 15% to 45% more on prescription drugs than other government programs, according to the U.S. House Committee on Oversight and Government Reform’s Federal Workforce, Postal Service and the District of Columbia Subcommittee. In order to cut costs, would you support the FEHBP implementing initiatives that are currently practiced in other government drug programs that have lower costs?”
- “One definition of a fiduciary agent is someone that is required to work within and on behalf of the best interests of the person or group that they are providing a service to. A recent report by Change to Win found that many federal employees pay more under a FEHBP plan administered by CVS Caremark than uninsured patients when shopping at a CVS pharmacy for a number of prescription drugs. Would you support legislation that requires CVS Caremark to operate as a fully transparent fiduciary agent for the FEHB health plans that it administers?”
I wouldn’t expect any of the above questions to be any more leading than those asked by the PBMs.