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Pharmacy Benefit Managers Prepared for Introduction of Aduhelm

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Pharmacy Benefit Managers (PBMs) are constantly working to provide access and improve the affordability of prescription medications for patients. Recently, the Food and Drug Administration (FDA) approved the use of Aduhelm, a treatment for Alzheimer’s disease.

PBMs serve an important role as the hub connecting multiple aspects of the health care system that serves patients. Connecting different aspects of health care provides clinicians and health plan sponsors a line of sight into a patients’ total care — from medical to pharmacy treatment. PBMs are not only benefit managers, but care managers on behalf of patients.

This coordination of multiple stakeholders working together is an example of how new medications become accessible to patients, and a way that PBMs focus on safety. In the case of a drug like Aduhelm, this coordination is all the more essential. Aduhelm was granted accelerated approval, a pathway designed to provide earlier patient access to potentially valuable therapies where there is an unmet need, and where there is an expectation of clinical benefit but also uncertainty. That uncertainty includes a safety profile in which 40% of phase three clinical trial participants experienced brain swelling or bleeding. This new drug may represent a breakthrough for patients, but it also may not be for everyone. That is why the tools used by PBMs are so essential.

For example, PBMs empower patients and prescription drug prescribers to understand the known safety risks, side effects, efficacy, potential for drug-drug interactions, and clinical appropriateness of any prescription drug treatment. Giving doctors the ability, in real-time, to weigh the risks and benefits of prescribing medications for any given individual patient results in the right drug being prescribed at the right time.

For a drug like Aduhelm, PBMs’ care coordination work is designed to complement the FDA’s accelerated approval parameters to help physicians navigate a decision-making process that may be complicated by the additional evidence that must be generated as the FDA balances early access to this treatment against the fundamental considerations of safety and efficacy.

Much has been and will be said about this new treatment for Alzheimer’s. PBMs have a responsibility to leverage our care management tools to help both patients and federal regulators balance appropriate access and safety while additional evidence is generated about the risks and benefits of this drug. PMBs are ready to do what they do best — help patients get safe, appropriate, and affordable access to the treatments they need.

Read more about Aduhelm and how PBMs are always #OnYourRxSide on PCMA’s President & CEO, JC Scott’s Medium page.

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