Pharmacy Benefit Managers Expose Patients to Negative Health Outcomes, GHLF Updated Studies Shows

FOR IMMEDIATE RELEASE  

MEDIA CONTACT

Susan Jara

Phone: 201-406-7756

Email: sjara@ghlf.org

UPPER NYACK, N.Y.–(BUSINESS WIRE)–ESI and CVS Health continue to expose hundreds of thousands of patients to the risks of taking medicines their doctor did not prescribe, according to an existing peer-reviewed and updated study, and new research by the Global Healthy Living Foundation (GHLF).

The updated research found that more than half the exclusions (57%) had questionable medical or economic benefits for patients. The original peer-reviewed research and its update, which is not yet published, focuses on ESI, the second largest pharmacy benefit manager in the United States.

The new study includes CVS as well as ESI and looks at three drug classes — cardiovascular, neurologic, and dermatologic — to try to further quantify the number of potential patients harmed when drug availability is restricted, a practice known as formulary exclusion.

Profits Over Patients

“All studies exposed concerning trends in pharmacy benefit manager (PBM) formulary exclusions that prioritize more profitable drugs rather than those originally prescribed — putting profits over patients’ well-being and underscoring the need to enhance transparency and accountability in health care,” said lead author Robert Popovian, PharmD, MS, Chief Science Policy Officer at GHLF, Senior Health Policy Fellow at the Progressive Policy Institute, and Visiting Health Policy Fellow at the Pioneer Institute.

“Formularies were originally meant to help patients get cost-effective treatments and generic equivalents, but now they prioritize PBMs’ profits through rebate contracting schemes, often mandating substitution with a non-equivalent medication,” Mr. Popovian added.

“This means patients may not get the best treatment options, leading to mortality, morbidity, or worsening in quality of life.”

Co-author Anne M. Sydor, PhD, Director of Research Development and Communications at GHLF, said “We know that when certain medicines are excluded, it affects hundreds of thousands of patients, making them sicker and sometimes even putting their lives at risk. This forced switch to different medications also adds to the challenges patients and their caregivers face, and it ends up costing more for everyone involved in health care — patients, caregivers, employers, and the government. Ensuring that the well-being of patients takes precedence over corporate profits in health care decision-making is a paramount concern.”

For Catherine Hicks, who lives with JIA and epilepsy, formulary exclusions have stopped progression of care and needlessly worsened her condition. “Formulary exclusions almost killed me,” she said.

“Being without my medication that we knew worked, and going through the process of appeal and starting stop-gap measures such as steroids and trying other medications, made me extremely ill and landed me in the hospital for 10 days with acute pneumonia that teetered briefly into sepsis.”

For more information about these studies, please contact the lead author, Dr. Robert Popovian (rpopovian@ghlf.org).

GHLF will host a webinar concerning formulary exclusions and their impact on patients on November 9 at 12 pm EST. Click here to register.

About Global Healthy Living Foundation

The Global Healthy Living Foundation is a 501(c)(3) nonprofit organization whose mission is to improve the quality of life for people with chronic illnesses (such as arthritis, osteoporosis, migraine, psoriasis, inflammatory bowel disease, and cardiovascular disease) by advocating for improved access to health care at the community, state, and federal levels, and amplifying education and awareness efforts within its social media framework. GHLF is also a staunch advocate for vaccines. The Global Healthy Living Foundation is the parent organization of CreakyJoints®, the international digital community for millions of arthritis patients and caregivers worldwide who seek education, support, activism, and patient-centered research in English and Spanish through our ArthritisPower® (ArthritisPower.org) Research Registry. In response to the COVID-19 pandemic, GHLF started a Patient Support Program, informed by a patient council made up of people living with a wide range of chronic illnesses, that now serves more than 46,000 subscribers. Via CreakyJoints, GHLF also hosts PainSpot (PainSpot.org), a digital risk-assessment tool for musculoskeletal conditions and injuries, eRheum (eRheum.org), for telehealth and virtual-care support, and a constantly refreshed library of podcasts via the GHLF Podcast Network. Visit ghlf.org for more information.