Health Equity
Working together for a more equitable health care system.
Pharmacy benefit companies, in collaboration with plan sponsors, clinicians, and government programs, have a long history of working to advance health equity; however, the severity of the health disparities revealed during the COVID-19 pandemic spurred the Pharmacy Benefit Managers (PBMs) industry to develop a more unified response. In 2021, PCMA’s members came together to formally declare the PBM industry’s commitment to health equity and selected four key areas of focus:
Address Disparities in Access, Disease Burden & Outcomes
PBMs are advancing a range of strategies to improve alignment between the accessibility and experience of care and individual patients’ needs, preferences, and goals.
- Update Medicare Part D to make it even more affordable for beneficiaries with extremely high drug costs, including, in part, by repealing the rebate rule and allowing Prescription Drug Plans to use Medicare Parts A and B claims data to inform pharmaceutical care management.
- Improve affordable access to prescription drug coverage, vaccines, and preventative care, including preventive prophylaxis for HIV/AIDS, medication assisted treatment for substance use disorders (SUD), and overdose-reversal treatments for SUDs.
- Improve the use of PBM tools to promote clinically appropriate and timely access care.
- Build on the success of drug utilization reviews (IMPROVE Addiction Care Act).
- Promote partnerships to coordinate health and social needs (LINC to Address Social Needs Act).
- Support community approaches to address health disparities (Determinants Accelerator Act).
- Codify federal guidance allowing high-deductible health plans to provide pre-deductible coverage of preventative care for chronic conditions (Chronic Disease Management Act).
Promote Equitable, Affordable Pharmacy Benefit Design
Our industry is helping employers and other drug coverage sponsors advance equitable care through patient-centered quality improvement initiatives in areas of clinical vulnerability and disparities, such as diabetes and other noncommunicable diseases.
- Remove remaining barriers to the uptake of innovative payment and incentive structures that promote patient access to quality, affordable, and value-based care.
- Support the availability and use of real-world evidence in coverage decisions and utilization management.
- Promote cost-effective care and patients’ abilities to make informed therapy decisions.
- Encourage full adoption of electronic prescribing, electronic prior authorization, real-time benefit checks, and similar tools that help promote meaningful transparency.
- Support mechanisms for testing innovative payment models with aligned financial incentives to promote investment in public health and social determinants of health.
- Sustain public-private partnerships and private sector convening of health care stakeholders to update consensus-based tools, practices, and processes.
Create A Culture Of Equity & Person-Centered Care
We commit to sustained industry action on diversity, equity, and inclusion (DE&I) within our own workplaces; in partnership with stakeholders across our shared health care system; and in collaboration on behalf of patients with drug coverage sponsors, health care prescribers, and pharmacists.
- Promote culturally competent care.
- Support industry initiatives to develop and use unconscious-biases awareness and conscious inclusion training for all health care stakeholders.
- Incentivize and remove barriers to the widespread adoption of patient- and family-centered care.
- Update language access rights through improvements that clearly define and support “plain language,” readability, and accessibility, including for patients with disabilities.
- Promote a diverse and inclusive health care workforce by fostering DE&I dialogue throughout the health care ecosystem.
- Eliminate racialized and harmful language from the health care lexicon.
- Work with policymakers to integrate evidence-based solutions and address other policies that pose barriers to equitable care.
Invest In Meaningful Data, Evidence & Measurement
PBMs are actively investing in and advancing new ways to use available data and other indicators to advance equitable care.
- Facilitate clear understanding of patient privacy, confidentiality, and terms of use for collected and reported data relating to disparities.
- Improve health disparities data collection, quality measurement, and risk assessment.
- Encourage use of standardized data, measures, and protocols to promote and streamline patient collaborative care initiatives.
- Address gaps in clinical evidence data through more inclusive design of pharmaceutical clinical trials and sharing of subpopulation results.
Fulfilling Our Commitment
PCMA’s member companies are actively working to eliminate health disparities and fully intend to continue doing their part to achieve this goal. Members are also expecting improvements in clinical trial diversity and data stratification to use to increase personalized care and enhance formulary design. To further improve the ability to track, measure, and focus progress and ensure that care gaps are being closed, pharmacy benefit companies continue to work with policymakers and other stakeholders to improve demographic data collection.
PCMA’s members demonstrate intense focus on advancing health equity and being accountable for mitigating health disparities within areas of health care.
