The pharmaceutical benefit management (PBM) industry has apparently decided it’s time to buff its image. A new That’s What PBMs Do campaign has been launched by the Pharmaceutical Care Management Association (PCMA), which counts the big 3 PBMs and a few smaller ones among its members. Some articles speculate that the campaign is in response to scrutiny over the pending acquisition of Medco by Express Scripts. Although it seems a little bit unlikely that CVS Caremark would go along with that line of thinking, the pro-mail order and implicitly anti-drug store message of the materials does bear the handprints of Express Scripts/Medco.
The print ads and video make the following claims:
- PBMs reduce pharmacy costs for employers, unions, and consumers
- PBMs play a key role in the Medicare Part D success story
- PBM mail-service pharmacy improves safety, savings and convenience
Of the six print ads, four focus on how PBMs restrain costs: two are Medicare Part D related and there are one each for employers and employees. Two others focus on mail order: one emphasizing its safety (reduction in medication errors) and another its convenience. The text is quite spare –probably the less said the better, and the ads are dominated by photos of one or two people each. In keeping with PBMs’ end users, the people in the ads are generally on the older side.
The almost three minute long video covers many of the same topics in a little more detail. After a gentle introduction there’s a confusing and meaningless graphic at the 30 second mark showing that “the number of prescription drugs has skyrocketed in recent years.” There’s a bar graph with 1985, 1995, 2001 and 2011 on it. The y-axis is labeled “amount.” I assume this is the total number of SKUs out there including generic medications, but it is curious why it’s thrown in there. Maybe they didn’t want to demonstrate how drug utilization has risen and decided to put out a feel-good innovation message instead.
The video describes how PBMs negotiate discounts with drug manufacturers and retail pharmacies, employees thousands of pharmacists to counsel patients by phone in the privacy of their own homes 24 hours per day, provides home delivery, and uses e-prescribing technology to avoid drug errors. It boasts of PBMs’ role in keeping Medicare Part D costs under control and notes that the states generally don’t use PBMs for Medicaid, even as costs are “spinning out of control.”
On the whole the campaign is accurate. And it probably is a good thing that consumers and policymakers develop an understanding of PBMs. But there are certain omissions and misleading statements. For example:
- The ads treat PBMs and mail order pharmacies as the same thing. It leaves out the role PBMs play in adjudicating retail pharmacy claims, which is a major part of what they do
- There’s discussion of cost savings –with a focus on discounts– but not discussion of other cost savings strategies such as formularies, prior authorization and mandatory mail
- Rebates –which represent revenue from the pharmaceutical industry to PBMs– are not discussed
- There is no claim that PBMs –even with their pharmacists– achieve any clinical benefit from their activities