Private practice with Dr Seth Bilazarian

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Pharmacy benefits managers: A nuisance for the private practitioner?

May 28, 2009 09:30 EDT


Prescription fulfillment has changed radically over the past years, becoming markedly more complicated since the advent of pharmacy benefits managers (PBMs), which are third-party companies hired by insurance firms to manage the prescription formularies for the members of their plans.

PBM interventions can include notification of generic substitutes, more intrusive suggestions such as the addition of an ACE inhibitor based on guideline recommendations, or even weighing in on evolving fields such as the possible reaction of proton-pump inhibitors and clopidogrel.

What are your thoughts on PBMs? Are they invasive necessities or intrusive annoyances that create fresh levels of bureaucracy without adding value? What is your experience with PBMs?





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Your comments
Pharmacy benefits managers: A nuisance for the private practitioner?
# 1 of 2
June 18, 2009 01:49 (EDT)
E. Caceres, MD

They are intrussive annoyances without added value. Their information provided is irrelevant to patient care: they are "treating papers" so they could look better without having any contact with the patient. Most of the information send to my office is unrelated to my practice (cardiology).
# 2 of 2
June 25, 2009 07:14 (EDT)
Melissa

I've actually started to write back to them when I have time.  I just write a short note about how inappropriate their suggestion is so that they will be forced to analyze their comment just like I was forced to analyze theirs.  Recently, a suggestion came from one of the companies that would have caused an early stroke or death if I had followed their advice.  I can't recall the details this morning, but I remember thinking it would have been the most blatant medical malpractice I could committ on this particular patient.  I shared with them their ludicrous suggestion and pointed out why it was dangerous. I don't always have time to do this of course, but just address the most blatant ones.

Melissa

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About Dr Seth Bilazarian
Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine.

Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.

Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
About this blog
My intent is to create a forum for dialogue on issues pertinent to private practice cardiology around topics such as:

  • Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
  • Practice approaches to the extra clinical issues in dealing with managed care insurers
  • Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
  • Experiences with restrictions on testing and imaging
The video blog (VLOG) will provide an opportunity to share broadly different approaches to the common conundrums we face in caring for patients. My hope is that this forum will provide useful data points for practice outside of tertiary and academic centers and a look inside community hospitals and physician?s practice patterns in the office, starting with mine.