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Silver Lining: PBM Control of Drug Dispensing

09/14/2017

Reports of PBMs (Pharmacy Benefit Managers) like Express Scripts and CVS usurping the prescriber's role for controlled substance dispensing has drawn the ire of prescribers who decry an increase in administrative hassle. I see this as a step in the right direction toward lifting this useless and onerous responsibility, leaving prescribers to do what they train for: diagnose and recommend treatment.

Changes might include PBM restrictions on amount, dose form and even duration of action of drugs dispensed. PBMs may also address the problem of multiple prescribers and set limits accordingly.

I say this will make it harder to blame prescribers for overdoses and for "addicting" patients. For the plan to reduce the burden on prescriber, however, they will need to let go of the notion that they have a duty to obtain money (reimbursement) -- or drugs -- for the patient and leave it to the patient to fight the PBM, getting prescribers out of the dysfunctional middle.

Next step: Make all drugs available over-the-counter to adults without prescription.