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ASCO Analysis Finds Some Pharmacy Benefit Manager Practices May Erode Patient Access to Cancer Care

New Position Statement Highlights Range of Potential Harms to Patients, Recommends Changes to Specific PBM Practices


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ASCO warns that some of the practices used by pharmacy benefit manager (PBM) companies could hinder patient access to timely, high-quality cancer care. While PBM practices may be intended to help control costs in cancer care, in a new position statement, ASCO describes a range of practices that might compromise physicians’ ability to provide the right treatment at the right time for people with cancer; place patients at risk of serious complications due to drug-dispensing errors; or drive up out-of-pocket costs for patients. ASCO also recommends a series of actions to address PBM practices that interfere with the delivery of prescribed therapies.

Monica M. Bertagnolli, MD, FACS, FASCO

Monica M. Bertagnolli, MD, FACS, FASCO

“Examples are emerging of PBM practices that may place patients at risk of life-threatening complications,” said ASCO President Monica M. Bertagnolli, MD, FACS, FASCO. “There’s no doubt that the high cost of cancer care is a major burden on patients and the health-care system, but efforts to address the problem shouldn’t come at the expense of quality patient care.” 

Oncologists Identify Concerns About PBM Practices 

ASCO’s position statement, “Pharmacy Benefit Managers and Their Impact on Cancer Care,” outlines concerns expressed by the Society’s members about the negative effects of certain PBM practices on patients and the cancer care system. They include errors in filling prescriptions; treatment doses being altered without consultation with providers; treatment delays related to prior authorization requirements; duplicate patient copays due to incomplete dispensing; and drug waste resulting from incorrect doses or treatments being sent directly to a patient’s home.

PBM practices listed in ASCO’s position statement as leading to these harms include using “gag clauses” to prohibit pharmacists from informing patients about lower-cost drug options; requiring that patients use mail order or specialty pharmacies in lieu of a dispensing physician; and “brown bagging” and “white bagging” policies that require oncologists to administer drugs that have been prepared outside their offices.

Read the statement. ■

© 2018. American Society of Clinical Oncology. All rights reserved.


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