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PBMs Help Americans with High Cholesterol


Cholesterol is a substance in the blood that the body needs to build cells, create hormones and vitamins, and generally keep us healthy. We all need it. However, dietary cholesterol, which enters the body when you eat foods such as meat and dairy products, can lead to overproduction, which can be unhealthy, according to the American Heart Association.  

“High cholesterol has no symptoms, so many people don’t know that their cholesterol is too high,” according to the  Centers for Disease Control, adding that, “having high blood cholesterol raises the risk for heart disease, the leading cause of death, and for stroke, the fifth-leading cause of death.” 

Though a simple blood test is all that is needed to check cholesterol levels, high cholesterol is a problem that plagues many Americans. According to the CDC, 94 million Americans have cholesterol levels that doctors consider borderline high and another 28 million adults have cholesterol levels that are definitely too high. Though cholesterol can be controlled with medication, only 54.5% of those who could benefit from these drugs—about 47 million people—are actually taking it, according to the CDC.   

Thanks to the work of pharmacy benefit managers (PBMs) – which administer prescription drug plans for more than 266 million Americans with health insurance – patients with high cholesterol can get affordable access to the care they need. 

Matt, a marathon runner who surfers from high cholesterol, gets access to his medication through his PBM. “PBMs do a lot for me,” Matt says. “PBMs keep track of all of my medications, ensure there are no harmful drug interactions and make sure they do what they say they’re gonna do. And, thanks to my PBM, I have access to my medications at local pharmacies and through mail order. More importantly, I know exactly what that cost will be.” 

A National Bureau of Economic Research study called The Value of Pharmacy Benefit Management shows that PBMs create more than $145 billion in annual value. PBMs negotiate rebates from drug manufacturers, fight for discounts from pharmacies and promote the use of generic medications. They manage patient drug utilization, process prescription drug claims, manage the cost of expensive specialty medications, administer home delivery, work to reduce medical errors and develop pharmacy networks for health plan sponsors.  

Because of PBMs, patients like Matt get the care they need. Check out how PBMs are #OnYourRxSide here. 

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Pharmacy benefit managers (PBMs) are your advocates in the health care system, working to lower out-of-control prescription drug costs for patients across the country.

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