Pharmacy Benefit


Managers Driving up cost of your prescription drugs


mellanie true hills, who founded StopAFib.org, a non- profit patient advocacy organiza- tion for people living with atrial fibrillation, was on a statin to treat her underlying heart condi- tion. When a generic version of the medicine appeared on the market, she and her doctor were told her old drug would no longer be covered. She switched to the new one thinking everything would be fine. It wasn’t. In fact, within 48 hours of starting the new medi- cation, her right hand became completely immobile and para-


lyzed. She says it was a terrifying experience. Soon after discontinuing the new drug, Hills regained the use of her right hand. But it turns out that her prescription nightmare was just beginning, because her insurance company to this day keeps trying to force her onto a different statin. One year she even had to appeal to obtain the proper medicine. The prior authorization hoops she and her doctor have to jump through seem unending, she says. “Every single year,” she tells Newsmax, “I have to start the


process over again. My doctor has to write out the same thing that he wrote up last year and send it in. And we just keep going through this process over and over again.”


In fact, after her insurer


repeatedly denied her requests, Hills once had to appeal all the way to an administrative law judge to obtain coverage for her prescribed medica- tion.


Every single year, I have to start the process over again. My doctor has to write out the same thing that he wrote up last year and send it in. And we just keep going through this process over and over and again.”


— Mellanie True Hills


PBM stands for pharmacy benefit manager, third-par- ty companies that manage prescription drug benefits for health insurance providers. PBMs and insurance companies are laser-fo- cused on directing doctors to write scripts for the drugs that make them the most money. According to Hills, those medi- cations may not be the lowest priced or most effective. She puts the blame squarely on PBMs.


DECEMBER 2024 | NEWSMAX 65


HANDS/MONEY/DIY13©ISTOCK / HILLS/STOPAFIB.ORG


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