The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part II: Not What the Doctor Ordered - United States House Committee on Oversight and Accountability

The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part II: Not What the Doctor Ordered - United States House Committee on Oversight and Accountability

ElectronicMedicalRecords are a Mess... Here's Why. 50% of Patient Notes are Copied and Pasted. The University of Pennsylvania published a study that found that 50% of EMR text is copied and pasted.

In order to bill for patient visits, doctors must document specific phrases related to the patient's history and physical exam. This requirement stems from the numerous billing codes and documentation rules associated with each code. To save time and effort, doctors resort to copying and pasting their own notes or those of other doctors repeatedly, resulting in the electronic medical record (EMR) being filled with redundant and repetitive information.

The consequences of this practice are alarming. The average patient record is now 56% the length of Shakespeare's 'Hamlet,' making it an arduous task for physicians to sift through and find the important information buried within the copied notes. Imagine having to read an 85-page book just to understand the records of 10 patients. Considering that most physicians see more than twice as many patients each day, it's no wonder important details are often missed.

The role of Pharmacy Benefit Managers (PBMs) in prescription drug markets further complicates the situation. PBMs act as intermediaries between insurance companies, pharmacies, and drug manufacturers, with the aim of reducing costs and improving patient outcomes. However, their practices have come under scrutiny and raised concerns about their impact on the healthcare system.

One major issue with PBMs is the lack of transparency in their pricing arrangements. Despite being responsible for negotiating drug prices on behalf of insurance plans, PBMs often receive rebates and discounts from drug manufacturers, creating a conflict of interest. These undisclosed rebates and discounts can distort the drug pricing landscape and potentially lead to higher out-of-pocket costs for patients.

Additionally, PBMs employ formularies, which are lists of drugs that insurance plans cover and their associated copayments. While formularies serve as cost control mechanisms, they can also restrict patient access to certain medications. This can be particularly problematic for individuals with chronic conditions who rely on specific drugs for their well-being. The decision to include or exclude certain drugs from formularies should be based on medical evidence and not solely on financial considerations.

Moreover, the complex and opaque contracting and reimbursement practices of PBMs have led to concerns regarding their impact on independent pharmacies. Independent pharmacies often face challenges in competing with larger chains due to the lack of negotiating power and unfavorable reimbursement rates. This can result in limited access to care in rural areas where independent pharmacies are essential healthcare providers.

To address these issues and improve the state of electronic medical records and prescription drug markets, there are three actionable pieces of advice:

• 1. Enhance EMR systems: It is crucial to develop EMR systems that prioritize ease of use and reduce the need for copying and pasting. Streamlining documentation requirements and implementing features such as voice recognition technology can save time for physicians and improve the accuracy and relevance of patient records.

• 2. Increase transparency in pricing: PBMs should be required to disclose the rebates and discounts they receive from drug manufacturers. This transparency would allow for better understanding of pricing dynamics and ensure that patients are not unfairly burdened with high out-of-pocket costs.

• 3. Promote fair competition: Measures should be taken to level the playing field between independent pharmacies and larger chains. This can be achieved through policies that support fair reimbursement rates and provide incentives for independent pharmacies to operate in underserved areas.

In conclusion, the intertwined issues of electronic medical records and the role of Pharmacy Benefit Managers in prescription drug markets require urgent attention. By addressing the challenges of EMR systems and promoting transparency and fair competition in the pharmaceutical industry, we can strive for a healthcare system that prioritizes patient care, affordability, and accessibility.