We All Need Advocates
Matt is a marathon runner who was shocked to be diagnosed with high cholesterol. He’s glad to have a PBM keeping his costs low.
Matt is not just a runner. The 65-year-old has completed 14 marathons, including major races in Boston and New York that require athletes to qualify. At top form, before the pandemic, Matt could cover 26 miles in 3:17, a time that would make many runners envious.
So he was very surprised to hear from his doctor that he has high cholesterol—high enough to require regular medication.
“I was shocked,” Matt said. “I try to keep a pretty active lifestyle. I love to run marathons, go biking and kayaking.”
Indeed, few would guess Matt’s condition. He is lean and fit as he prepares to launch into retirement after a career in information technology. But, as Matt explains, there’s more to cholesterol than lifestyle.
“I have a genetic predisposition to high cholesterol that can’t be controlled by diet and exercise alone,” he said. “So I have to depend on three medications to keep it in check. Without these medications, my life can be at risk. Risk of a heart attack. Risk of a stroke. I really depend on these medications to stay healthy.”
PBMs lower the cost of prescription medication by 40% to 50%, according to a study by the Bureau of Economic Research study called The Value of Pharmacy Benefit Management. Annually, PBMs save payers and patients an average of $962 per person.
Matt relies on a pharmacy benefit manager, or PBM, to make sure that his medication is available when he needs it and at a cost that he can afford. He is grateful for the help.
“Access to affordable medication is hugely important to me because I plan to retire soon and I’ll be on a fixed income,” Matt says. “That’s why I’m very thankful for pharmacy benefit managers, because they help negotiate with big drug companies to keep my prices in check.”
“We all need advocates,” he said. “Thank heaven we have PBMs out there, because they’re looking out for the little guy.”
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.
“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,” Matt says. “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. Watch Matt tell his story 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.