PBM aka “Invisible Robber Barons” ~ Don’t Shoot The Messenger

I didn’t make that up myself, I promise…

In my new quest to get a job as a PBM pharmacist, I am researching all there is to know about the PBM industry because it is completely new, and dare I say, “foreign”, to me.

Yes, I’ve heard of them, but not having worked in retail for more than a moonlighting shift here and there, I really don’t know much about what they do or how they function.

So I headed to my trusty public library to find some books to read on the subject. For whatever reason, the pickings were slim, but I think that’s because most people have no idea what PBMs are or how important of a role they play in today’s American healthcare system.

Ah… But this one author does…

I found a book about the broken American healthcare system (actually, there were many of them), but most of the authors made no mention of PBMs, except this lady – Elisabeth Rosenthal – in her New York Times Bestseller “An American Sickness – How Healthcare Became Big Business & How You Can Take It Back“.

Somewhere nestled in one of the mid-book chapters I saw that she’d devoted about a page and a quarter to PBMs. A-ha!

Here’s what Ms. Rosenthal had to say about them (in summary):

• She describes them as “backroom mercenaries” that have enormous sway over the care of patients
• She named the three largest ones – Express Scripts, CVS Caremark, and OptumRx
• They are hired by employers (some… many, but not all) and insurers to act as middlemen in the negotiation of drug purchases with pharmacies. And here’s the kicker…
• They (PBMs) occupy a place of “business advantage”
  • Why? Because antitrust laws and contractual gag clauses prohibit insurers from comparing drug pricing but the PBMs… These “invisible robber barons” know ALL the deals and have major negotiating power…
• PBMs negotiate the best deals that will earn them the highest profit margin (Note: PBMs are for-profit organizations); they make their money by taking a percentage of the discounts they negotiate
• The ever-changing drug formularies of different insurance companies most likely has everything to do with negotiating tactics that result in higher profits for the PBMs and virtually nothing to do with what’s in the best interest of the health of patients

So… To say the very least, Ms. Rosenthal has some very strong (and negative) opinions about PBMs.

That’s not to say that I disagree or agree with her…

At the beginning and end of the day, I’m just a pharmacist trying to get a job. However, the idea of this new industry I want to get into being described as mercenaries does give me some pause…

Do I really want to be associated with a system that puts profits over patients (and in some cases, might actually cause patients harm) when my reason for pursuing a career in healthcare was to help patients and not hurt them?

Can I honestly try to make myself feel better by saying “maybe I’ll change things when I’m on the inside”? Am I naïve enough to believe that I could possibly change a system as Goliath-ey as the PBM industry?

The more compassionate side of me wants to say “Just walk away…” But the pragmatic side of me says “You need a paycheck… Do good in your sphere of influence…”

So I’ll be pragmatic.

What I’ve Learned

Thanks to Ms. Rosenthal, I have three companies to start off my job search with – Express Scripts, CVS Caremark, and OptumRx. I will look at their company career sections to see what’s available.

I read the latest edition of What Color Is Your Parachute by Richard Bolles and one of the recommendations he made was to apply for jobs at companies with fewer employees… The fewer the better.

Based on that recommendation, I won’t put all my eggs in the basket of these big PBMs, I will do some research to find out which smaller PBM companies are out there and apply to those as well, and try to network with people who are working there and are in the positions I want to get (this too was a recommendation made by Mr. Bolles in the Parachute book).

This means I might have to start attending some local MeetUps and also spruce up my LinkedIn profile… But first, I have to remember my login info for LinkedIn… Ugh…

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It occurred to me that I probably shouldn’t end this post without giving another point of view of what PBMs do so I found this YouTube video put out by Express Scripts that defines PBMs from their own perspective.

Quite different from what Ms. Rosenthal says…

 

What has been your experience, if any, with PBMs?

Tell me in the comments section below.

PS: if you landed here because of Epic Willow Pharmacist journey and you missed the post where I explained my new change in course, you can check it out here.