Q&A: How PBMs Impact Patient Care

From offering education to helping find a medication that’s unavailable at the pharmacy, community pharmacists pride themselves on the relationships they create with their patients and customers. Many independent pharmacists and community pharmacy owners will tell you that they did not enter their industry to become rich, rather they became pharmacists to make an impact for patients in their communities.

Tom DePietro, PharmD, owner of DePietro’s Pharmacy in Dunmore, Pennsylvania, sat down with Drug Topics to discuss what patient care really means to him. In an overarching discussion around pharmacy benefit managers (PBMs), he explained how these pharmaceutical middlemen manipulate drug pricing and force patients around the country to be complacent when it comes to medication management.

"I often say to my patients, “You're a human first,” and I'm always going to refer to you by your name, but I don't think that pharmacy benefit managers have that instilled in their practices," said DePietro. | image credit: J Bettencourt/peopleimages.com / stock.adobe.com

From the pricing side of the supply chain with PBMs and manufacturers to the pharmacists dispensing medications to their patients, DePietro explored the ongoing corruption within the supply chain and how it affects patients.

In part 1 of his interview with Drug Topics, which will be available on Over the Counter, DePietro discussed overarching themes within the drug supply chain and its current state amidst ongoing reform efforts directed at PBMs.

Drug Topics: While a majority of the public is pointing the finger at PBMs for downfalls within the drug supply chain, do you believe other entities are responsible for rising drug costs and community pharmacies shutting their doors?

Tom DePietro: You'd have to think so, right? And it’s a question I ask myself all of the time. I know the PBMs point the finger at the drug manufacturers and the drug manufacturers are pointing back at the PBMs. I often will say, regardless of the situation, “Follow the money.” And if you follow the money, it's going to take 2 to tango. You have manufacturers that are forced to give rebates to get onto the PBMs’ formulary. When you have 3 PBMs that control 80% of the market, the drug manufacturers have to play the game. And to play the game, they have to offer rebates. The way that the system is set up, if they don't offer the rebates, they're not going to get preferred on a formulary and they're not going to sell their product.

There's definitely room but I think we're past the point of pointing fingers. I think we're past the point of who's to blame. I think we have to roll up our sleeves as a nation and say, “Okay, this is where we're at today, how do we how do we move beyond here? How do we fix this problem that we're at?” And I just think our country has become so divided in general that we just get stuck in this rut of saying who's better than who and who's to blame? We need to find a solution because, at the end of the day, there's patients that are suffering, waiting, sitting by their mailbox, waiting for their cancer medicines to show up and they never show up.

I spent the Fourth of July last year getting a call from a dad, and his daughter, who was 12 at the time, was supposed to get a chemo drug mailed to her and it was supposed to arrive the day before the July Fourth holiday. It’s medication I don't dispense. So, I spent the day calling local hospitals and trying to borrow a drug for the patient. Luckily, I found an inpatient hospital that had the medication that allowed me to borrow it. [I] drove to the family member's house to give them the medication. This is the stuff that's happening across the country. [There are] pharmacists that are doing this stuff. We don’t talk about it because it’s just part of what we do. It’s in our DNA to help our patients.

[We’re] trying to overcome the shortcomings of the mail order and trying to overcome the shortcomings of PBMs to serve our patients. I'm not looking for a gold star. I'm not looking for a monetary figure, but that day I spent running around on the Fourth of July holiday looking for a chemo drug for a 12-year-old patient; I didn't get paid for it. I didn't complain. At the end of the day, we're disservicing our health care system. We’re supposed to be the greatest country on Earth but our health care system is just getting bogged down by red tape and dysfunction of these corporations. The impact of the patients is just too much for them to handle anymore and they just can't even navigate it alone.

Drug Topics: If you ask pharmacists and other health care providers the most important aspect of their work, many will say that it is providing their patients with care of the utmost value. How do you think patients around the world are viewed in the eyes of major PBMs?

Tom DePietro: I hate to say it because I hate to answer it so quickly. But I think, unfortunately, the patients are viewed as a dollar sign. In the world of insurance companies, they refer to patients as belly buttons. Often times, if you're talking with an insurance company and you’re working and saying, “Look, I have this employer group.” [They’d say,] “Okay, well, how many belly buttons is that?” What they mean by that is like, how many people are in the group and they’re referring to them as actual belly buttons.

To me, I often say to my patients, “You're a human first,” and I'm always going to refer to you by your name. But I don't think that pharmacy benefit managers have that instilled in their practices. I'm not saying [that it’s] across the board. I'm sure there's definitely caring, compassionate pharmacists and clerical staff that really take to heart what they do and serve their patients. I'm not saying everybody that works for a PBM is this evil person that's looking just at the patient as a dollar sign. But from a corporate standpoint, I believe that's what they’re viewed as unfortunately.

Stay tuned for part 3 of our Q&A series with Tom DePietro.

Don’t get left behind: Sign up today for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips delivered straight to your inbox.