National Diabetes Month Viewpoint: Pharmacy Benefit Clinical Care Programs Work, This Is My Family’s Story

I have been the Head of the Research Team at PCMA, representing the pharmacy benefit industry, for nearly four years. And while it is part of my job to research and write about the clinical care activities of pharmacy benefit managers (or PBMs), I have also seen firsthand how these programs work and why what PBMs do for patients is so important. This one event was an eye-opening reminder that what we do matters for patients. (I purposely kept the details vague for privacy reasons.)

My stepfather has had type 2 diabetes for nearly as long as I can remember and takes several medications to manage his condition. He recently told me about a phone call he had a few months ago with someone from his PBM.

The issue? Unbeknownst to my mom or his doctor, my stepfather had not refilled one of his antidiabetic medications used to control blood sugar in a long time. His PBM noticed and took action.

The pharmacy expert who called him expressed concern: Why hadn’t he refilled his prescription and was he still taking the drug? My stepfather explained that he had been taking it only at dinner time. This particular medication requires that a blood glucose reading be taken before every meal. Then, the amount of medication taken is determined by the reading. The PBM specialist deduced that my stepfather was not taking his medicine correctly and kindly explained that he should be testing before breakfast, lunch, and dinner and then taking the appropriate amount of medication before all three meals, which was written on his pill bottle label. Together, they came to the conclusion that the prescription was lasting a long time – and therefore was being under-refilled – because he was under-medicating.

The medication was new to his doctor-prescribed diabetes management regimen. He has a device that constantly monitors his blood glucose levels throughout the day, and the device identified that he had blood glucose spikes in the evening. He spoke with his doctor about those evening spikes and was prescribed this new medication to address them. Spikes at other times of the day were not discussed. He walked away from that discussion thinking he needed only to take this new medication at dinner time. The call from his PBM pharmacy expert set the record straight and he has been taking the medication as prescribed ever since.

My stepfather was grateful the process could be so easy. My mother and I were grateful that someone identified an issue and a solution before there was even a problem.

I knew that PBMs offered these types of services to their patients. It’s my job to know that they do far more than just negotiate drug discounts, and they also engage patients with diabetes directly through clinical programs that promote adherence and healthy lifestyles. But with this personal experience, I saw for myself just how PBMs are looking after the health and well-being of my family.