Many patients rely on prescription drugs to lead healthier and happier lives. Pharmacy benefit managers (PBMs) are on the front-line helping patients efficiently obtain their prescriptions at the pharmacy and monitoring for patient adherence and medication safety.
In 2019, over 3.6 billion prescriptions were filled in retail pharmacies by people with insurance. That’s a lot of prescriptions being filled every day, so it’s important that patients are able to pick up their prescriptions at the pharmacy counter as efficiently as possible, which involves combining disparate information and expertise, combined with advanced technology. We sometimes call this aspect of our work “PBM-patient care coordination.”
Here’s how a patient’s journey from receiving a prescription to obtaining the drug happens. Imagine a patient at the pharmacy counter: the pharmacy inputs the prescription information from the prescriber and sends it electronically to the patient’s PBM. In real time and nearly instantaneously, the PBM checks the patient’s pharmacy benefit information, the patient cost- sharing amount, and looks at the medication and patient history for any errors and possible harmful dangerous drug interactions (meaning the PBM can determine if the prescribed drug shouldn’t be taken by that patient at that time). Assuming there are no red flags, the patient pays their cost sharing and receives their medication from the pharmacist.
And when daily clinical care activities meet advanced technology, patients are able to take more control over their own health. You may be thinking, “Huh? I thought PBMs just manage drug benefits and reduce prescription costs.” They definitely do. But PBMs are also health technology companies. Apple, Google, and Facebook (now Meta) aren’t the only ones developing wearable technology and apps. Here are some of the ways PBMs are innovating and actively engaging patients to improve their quality of life and health outcomes:
- Wearable tech can allow for patient monitoring and alerts; for example, wearable biosensors are a non-invasive way to monitor glucose levels for patients with diabetes. Continuous Glucose Monitors (CGMs) are a non-fingerstick way to measure blood glucose levels. CGMs are wearable devices with tiny sensors placed under the skin, usually the torso or upper arm, and held in place with a patch. The patch can be worn for seven to 14 days. The sensors provide readings every few minutes that can be sent to a smartphone, allowing patients to track their levels anytime and monitor changes over time. PBMs help patients access CGMs and provide remote monitoring and measuring of glucose levels, even conducting patient outreach if needed.
- Digital apps can track medication use for patients to help them stay on their prescription medications. These apps allow the user to easily track and share their medicine records with family and doctors from their phone. Patients can also receive notification reminders to their phone when it’s time for them to take their medicine. Some apps even notify patients when they’re running low and need a refill to ensure the patient reorders before running out.
- Pharmacogenetics programs can identify therapies based on a patient’s genetic makeup – which can optimize patient care and eliminate unnecessary interventions. Having the knowledge of how a patient will react to a drug based on pharmacogenomic testing allows the providers to prescribe the right medicine for that individual, which leads to fewer adverse events and safer prescribing.
Through the din of the drug pricing debate, there are innovations and technologies that are leading to more efficient patient care and better health outcomes, which is a key component of the PBM mission.