But before we get to the fun part, we have to take a minute and discuss an important topic. A PBM, or pharmacy benefit manager, is the middleman between pharmacies and insurance companies. Their job is to contract with both the pharmacy and the insurance company to handle claims solely related to prescription medications. Currently, PBMs are not required to register with any overseeing body, and so they are free to do what they want. PBMs set the prices they are willing to pay to pharmacies when a pharmacy dispenses a prescription for a patient, regardless of the price that it actually costs to dispense the medication. These prices are oftentimes not enough to cover the cost of the medication, let alone pay the pharmacy for doing it’s job. Additionally, PBMs might only cover a small percentage of the cost of the medication, leaving the patient with a copay that is simply too expensive. Because these PBMs aren’t overseen by anyone, they can adjust prices as they please and are not required to report where or how they came up with their pricing list. This is why it is so important to work to expose the PBMs and make sure they are being regulated. This is where the fun part comes in - and this is where we need your help the most!
On November 1st, the American Medical Association launched a new national campaign, called Truth in Rx, that strives to get patients more involved when it comes to the rising prices of their prescription medications. The following is their mission:
“A price with purpose. People have a right to know why the price of their prescription medication fluctuates year after year when its ingredients stay the same. That’s why we’re on a mission to uncover the truth behind prescription drug pricing – join us.”
Their website is interactive, visually appealing, very user-friendly, and easy to navigate. Their homepage scrolls down quite a bit as it tells the story of a made-up medication to creatively illustrate why you do not want to deal with secretive drug pricing. The website also contains four very useful tabs, which are described in detail below.
Our Campaign: This tab shares the goals and mission of this campaign. Their goals are to make pricing transparent, restore affordability, and put patients over the middlemen. Their mission is to educate patients on why their medications are so expensive, and get them involved in speaking out and making pricing more transparent.
Your Stories: This tab provides a platform for you to share a story, share a photo, or share a fact about prescription drug pricing hikes and how it’s affecting you. This could also be updated by medical professionals, including pharmacists and pharmacy technicians, to provide stories from a different perspective. The hashtag #TruthinRx can be used on Facebook, Twitter, and Instagram to help spread the word.
Get Involved: The "Get Involved" section provides a template that can be used to send a letter to your U.S. Senators and Representatives regarding rising drug prices. The letter is already complete and can be sent as is, but adding a personal story is a welcome touch. You can send it through email or snail-mail. To send the letter through email, you’ll just need to enter your email address, home address, and phone number. To send it through the mail, you’ll have to copy and paste the letter into a Word document. You’ll also need to look up who your US Senators and Representatives are and find the addresses for their offices. By sending it via email through the website, it will determine who it needs to be sent to, making the process easier for you.
Get Informed: This is where you can find a myriad of resources which link to outside websites that provide answers to common questions, like why prices are rising, who is setting the prices, how drug pricing affects patients, and what’s being done to help.
So back to the questions I started with - if you answered yes to any or all three, you are exactly the person we need to help us get the word out and get the PBMs regulated. Please take a few minutes to share your story on Facebook or Twitter, and send a letter to your US representatives. While I wrote this, I also sent a letter through the Truth in Rx website to my representatives, and it took me less than five minutes. I even received a response back from one of my Senators before I finished writing this post!
Vince Lombardi once said, “Individual commitment to a group effort - that is what makes a team work, a company work, a society work, a civilization work.” This is why you are so important to uncovering the secrets of drug pricing. If we want to see change, we must work at it together - the time is now.