What should infectious diseases clinicians know about pharmacy benefit managers and their impact on our patients?

TL;DR

This paper explains how Pharmacy Benefit Managers affect medication access for infectious diseases patients and suggests ways to improve equitable treatment.

Contribution

The paper provides insights into PBM practices and their specific impacts on infectious diseases care, offering mitigation strategies.

Findings

PBMs can delay treatment and increase costs for vulnerable populations.

Infectious diseases patients face challenges due to PBM transparency and administrative complexity.

Mitigation strategies are proposed to improve medication access for these patients.

Abstract

Pharmacy Benefit Managers (PBMs) are contracted by health plans, employers, and government programs to manage pharmacy and prescription drug benefits. They maintain drug formularies, process and pay pharmacy claims, establish and manage pharmacy networks, and negotiate prices with manufacturers and pharmacies. Despite PBMs’ role in cost management, their lack of transparency and complex administrative processes can delay treatment and increase out-of-pocket costs, affecting vulnerable populations like those in pharmacy deserts. These factors influence healthcare delivery for persons living with human immunodeficiency virus, Hepatitis C Virus, and other conditions. Herein, we describe PBM practices and their impacts on infectious diseases patients and highlight mitigation strategies to facilitate timely and equitable medication access.

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