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PBMs: An Unexpected Ally in Patient Care

Brian K. Solow, MD, July 30, 2009

Support with Medication Compliance
PBMs can also help patients to be more compliant with their medications, which is a huge challenge for physicians, as well. Some PBMs offer programs for physicians that identify patients who are not taking medications as prescribed and help them to directly reach out to those patients, thereby improving adherence and outcomes. Some PBMs also have clinical management expertise to improve medical outcomes. They offer disease therapy management programs, for example, to help manage the medication therapy component for patients with chronic illnesses. The goal of these programs is to improve patient compliance, which will improve outcomes over time.

Increase the Use of Generics
PBMs encourage the use of generics for two reasons: a generic drug is therapeutically equivalent to its branded counterpart, and the cost savings from using generics help everyone control their prescription drug costs. Among the efforts that some PBMs make to ensure physicians stay abreast of what is going on in the world of generics is direct contact to let them know about the availability of a new generic drug. Another method is direct mailings to physicians with information on generic drugs, along with identification of patients who are taking branded drugs for which generics are available. The mailing may be followed by contacting the doctor to suggest the generic alternative.

Information on a Broad Range of Drugs
It's estimated that the average physician is primarily familiar with the 100 or so medications prescribed most frequently. Yet there are hundreds of other potentially beneficial medications. For example, specialty pharmaceuticals represent promising, yet costly drug therapies. PBMs can offer doctors clinical insights and knowledge about the latest therapeutic advances to help them better sort through and identify the medication regimens so that their patients that can best benefit from new treatments, new pharmaceuticals, and new biologics.

PBMs offer a real value to physicians by helping them to help their patients. Most PBMs are not trying to limit medication utilization or limit the prescription choices of doctors. Instead they are promoting the appropriateness of prescription medications with a focus on the clinical efficacy and quality. Looked at from this perspective, it makes sense for physicians to use the information and services PBMs provide for the benefit of their practices and their patients.


Brian K. Solow, MD, FAAFP. is vice president and medical director for Clinical Services at Prescription Solutions, a UnitedHealth Group company and a PBM that manages the drug benefit of commercial, Medicare, and governmental health plans, as well as employers, union trusts, and third-party administrators. For information, visit www.rxsolutions.com.
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