PBMs Help Facilitate Patients Access to Safe, High-quality Drugs through Formularies
What is a prescription drug formulary?
A prescription drug formulary is a list of drugs that a health plan covers under its pharmacy benefit. Prescription drug formularies are managed by Pharmacy and Therapeutics Committees (P&T Committees), which are comprised of a diverse group of healthcare professionals and experts including physicians, pharmacists, nurses, and clinical specialists. The P&T Committee provides an evaluative, educational, and advisory service to health plan sponsors to promote the safe, appropriate, and cost-effective use of prescription drugs in patient care. Health plan sponsors utilize the formulary recommendations and medication-use policies developed by a P&T Committee to optimize care for North Carolina patients and ensure access to safe, high-quality and cost-effective drugs. Importantly, and reflecting a requirement of PBM accreditation, P&T Committee members must disclose and appropriately handle any conflicts of interest.
Formularies are kept up to date by this panel of experts that review the latest medical literature, FDA-approved prescribing, and safety data.
There are many benefits to prescription drug formularies for North Carolina patients. For example, formularies can help patients avoid receiving unsafe medications that may not interact well with other medications, prevent expensive or ineffective drugs from being prescribed to patients, and improve patient outcomes by reducing physician or ER visits.
How North Carolinians can get involved
In the COVID-19 pandemic, PBMs are working with health plans, prescribers, drug manufacturers, pharmacists, and federal and state agencies to make sure patients in North Carolina continue to receive their prescription drugs in a safe, efficient and affordable manner.
To mitigate the adverse effects that COVID-19 has on patients and communities across the state PBMs are:
- Working with pharmacy partners to assist with mailing prescriptions.
- Temporarily waiving requirements for pharmacies to obtain proof-of-receipt signatures from patients, unless required by law.
PBMs are also leading collaborative efforts with industry stakeholders, including pharmaceutical manufacturers, pharmacies, hospitals and health plans, to minimize the potential for a shortage of any drug for North Carolinians. If patients encounter a disruption for a specific medication, PBMs stand ready to work with both prescribers and health plans to identify covered and acceptable therapeutic substitutes.
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