PBM tries to get doctors to write more expensive drug

Any primary care doc can attest that the pharmacy benefit manager (PBM) companies try to get doctors to write cheap generic drugs in place of expensive branded medications, regardless of whether that is in the patient’s best interest.  Dr. Doug at the Placebo Journal Blog reports that Caremark is doing the opposite:

Caremark has been sending letters to doctors prodding them to add Januvia to specific patients’ treatments. How is that for patient privacy? The letter tells the physician how CVS went through a thorough review process to identify which patients would benefit from the switch. It also states at the bottom that Merck, which happens to make Januvia, paid for the whole thing.

Whatever the merits of Januvia  — Full disclosure: Drug reps from Merck have paid for my lunch on numerous occasions —  the point here is that PBMs often wield considerably more practical influence on what drugs patients get than do the usual suspects: so-called “Big PhRMA”.  Usually they use the “sentinel effect” of trying to deter physicians from writing expensive (but sometimes necessary) prescription drugs by refusing to pay for them unless physicians or office staff fill out prior authorization forms or spend time on the phone with a prior auth drone that could be spent taking care of patients.

When the PBMs and the pharmaceutical industry start working together to try to influence physicians to write more expensive drugs, it demonstrates the problem with having third parties interfere in the physician-patient relationship.

Starting in 2009, new PhRMA guidelines will restrict drug reps from “influencing” doctors with such trivial marketing items as pens or mugs with the names of their drugs on them.  If that is considered undue influence, then what will be the fallout of Caremark-Merck-Januvia incident?

Much less than should be, I suspect.

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