Asthma is a chronic respiratory disease that affects 1 in 13 Americans and causes irritation in the airways. Financially, asthma costs the U.S. over $50 billion a year in medical costs. Those living with asthma can also rack up much higher medical bills than those who don’t, to the tune of over $3,000 more for medical costs annually. Although there is no cure for asthma, several different medications can be used to control it. That’s where pharmacy benefit managers (PBMs) come in: PBMs help to reduce the cost for patients by negotiating with drug manufacturers and pharmacies for prices, including for asthma drugs, and help patients access the drugs they need.
PBMs work to help patients stay healthy and avoid emergencies by offering programs to help people living with asthma access and stay on their medications. PBM programs enable health plan sponsors to give patients, including those living with asthma, zero or very low cost sharing, including allowing them to bypass their deductible entirely. Other programs utilize claims data (a patient’s interaction with the healthcare system) to monitor whether a patient is on the appropriate asthma medications. If the patient is not on the right medication, has not filled prescriptions, or needs supplemental medication, their PBM will reach out and provide educational materials or counseling.
To help patients stay on their medications, some PBMs send asthma patients a device to attach to their inhalers to track usage. That device links to patients’ phones, which allows usage and dosage information to be sent to their PBMs. A PBM can then use that information to remind patients directly or via their physicians or pharmacists to use their inhaler consistently, which will lead to better health outcomes.
PBMs create these programs to ensure that patients have and use the prescription drugs they need to avoid asthma attacks and stay well. PBMs will continue to look for creative, patient-friendly ways to help asthma patients manage their conditions.