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Understanding Pharmacy Benefit Managers and PBM strategy feat. Rachel Strauss
Manage episode 441407960 series 3490450
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Rachel Strauss, the self-described ‘PBM Princess,’ is also the Vice President of Strategy for EHIM powered by ProCare. Rachel shares her unique journey into pharmacy benefit management (PBM), a field many may not be familiar with. With a love of pink and glitter and a passion for making the PBM world more approachable, Rachel explains the value of PBMs and how she was introduced to this role.
DISCLAIMER: This podcast is for informational purposes only and should not be considered medical or health advice. This podcast does not substitute medical treatment. Always consult a doctor or dermatologist regarding medical advice, diagnoses, or treatment.
A Pharmacy Benefit Manager is an intermediary between health insurers, pharmacies, and drug manufacturers. They manage prescription drug benefits for health plans, negotiating prices and determining which medications are covered. Rachel explains that most people are unaware of PBMs and their significance, often assuming that their health insurance provider is solely responsible for their prescription coverage. In reality, many insurance companies outsource their pharmacy benefits to PBMs, which handle the logistics of drug pricing and distribution.
For patients navigating the complexities of their pharmacy benefits, Rachel offers several strategies:
- Understand your plan and familiarize yourself with the company's health insurance plan and the specific pharmacy benefits it offers. This includes knowing who the PBM is and what medications are covered.
- Communicate with HR or Brokers if you need clarification on your coverage.
- Explore Cost-Saving Options like international drug options or patient assistance programs. Many manufacturers offer assistance regardless of income level, which can help patients afford their medications.
- Be Proactive: Patients should take the initiative and seek clarification about their medications, especially regarding prior authorizations and potential out-of-pocket costs.
This episode is produced by Skip The Boring Stuff, a podcast strategy company for small business owners.
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