Rotten Fruit Basket

After listening to the Pharmaceutical Care Management Association (PCMA)’s testimony last week at the Missouri House Health & Mental Health Committee Hearing for House Bills 1850 & 1975, we found a few discrepancies.  

First off, what are they supposed to be managing?  Pharmaceutical care was originally defined as “the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life,” by Hepler & Strand in 1990.  Numerous groups have re-defined the phrase since then to fit their own desires and agendas, but the original definition should ring true for any group claiming to be performing such… By his own admission, Mr. Phillip Christofanelli states that PCMA’s primary purpose is a trade association that represents Pharmacy Benefit Managers, or PBMs.  Later, he states that the primary purpose of PBMs is to negotiate terms between the complexities of healthcare, for the best price to the consumer.  Nothing to manage pharmacies, nor to manage care directly, per se.  

Mr. Christofanelli admits that “a particular drug” may be paid below costs, but that contracts are made with Pharmacy Service Administrative Organizations (aka PSAOs) as a “basket of goods” and that the picture must be looked at over that entire basket.  So, if a single pharmacy doesn’t represent the entire basket equally, that pharmacy may be at a disadvantage with the PBM contracts.  As such, he says it will balance out because some drugs will be less of a margin and others will make more of a margin, to balance out equally.  

My question for you, however, is if you go to buy a fruit basket, are you going to accept that basket as fully relevant and worth your purchase if half of the fruit in that basket is actually rotten?  Did you get a bad deal, or since the outside looked pretty and that fruit was good fruit, then the entire basket must have been acceptable and worth your investment?