PBMs are facilitating coverage of these drugs for weight management, but Big Pharma companies
are still shifting blame for their high prices onto PBMs.
GLP-1 drugs can help support patients in reaching their weight loss goals, which also has the potential to lower health care costs and improve other health-related issues associated with obesity. Right now, pharmacy benefit managers (PBMs) are using their expertise to support employers and other health plan sponsors when they decide to cover GLP-1s for weight loss as part of their prescription benefits.
A recent article in Modern Healthcare reported that, “employers strained by increasing costs and growing demand for blockbuster weight-loss medications are doubling down on partnerships with the biggest pharmacy benefit managers.”
PBMs are offering comprehensive programs to help the right patients access these drugs, combined with services that will help maximize the chances of long-term treatment success. The programs generally consist of a behavior support component to help patients make permanent obesity-related changes, including diet and exercise, alongside using GLP-1s.
PBM Innovations
Putting Patients at the Center
However, the promise of GLP-1s is threatened by the interconnected challenges of high price tags, a lack of competition in the market, and unprecedented consumer demand. Drug companies continue to play games with patents, jeopardizing the potential to get more patients covered. A JAMA study found that drug companies have amassed a median of 19.5 patents per GLP-1 drug, and 54 percent of patents were for the device delivering the drug and not for the drug itself. The results are high prices that drug companies alone set, creating affordability challenges for employers and patients.
Promoting access and affordability of GLP-1s is just one of the ways that PBMs are responding to an evolving market and innovating to meet consumers’ needs. Policymakers should recognize the numerous ways the drug supply chain is changing, and PBMs are adapting, and reject misguided proposals that would disrupt the progress already underway.
This is the third post in PCMA’s PBM Innovation Project series, highlighting how PBMs are putting patients first and responding to market demands.
Read more about these innovative programs HERE.
Explore the full PBM Innovation Project HERE.
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PCMA is the national association representing America’s pharmacy benefit companies. Pharmacy benefit companies are working every day to secure savings, enable better health outcomes, and support access to quality prescription drug coverage for more than 275 million patients.
