Pharmacy Benefit Managers are companies responsible for securing the best health outcomes at the lowest costs for employers, labor unions, and health insurers. They act as third-party companies or intermediaries. Various government and corporate entities contract them to negotiate with pharmacies and drug manufacturers.

Pharmacy Benefit Managers came about in the 1960s to help insurers manage their drug spending. Later, they began adjudicating prescription drug claims and developing and managing pharmacy networks. When new drugs emerge, PBMs engage in negotiations with the manufacturer on behalf of the companies or insurers through which the manufacturers give them rebates. The benefit managers then reimburse the pharmacy for dispensing the prescription on behalf of the insurance companies.

Most Pharmacy Benefit Managers function as part of major chain drug stores, integrated healthcare systems, retail pharmacies, or as subsidiaries of insurance companies. The role of PMBs includes negotiation of rebates and discounts and contracting with pharmaceutical companies to reimburse them for dispensing drugs. They also develop formularies on behalf of health insurers that help individuals determine what drugs to use and the costs. They create these formularies with various physicians and experts to ensure that patients have the best possible solutions.

PBMs allow individuals greater access to affordable medication and healthcare through their extensive network of retail pharmacies. The Step Therapy Programs are suited for these functions. These programs cater particularly to individuals that take prescription drugs regularly. It aims to provide cheaper medication alternatives to patients by allowing them access to cheaper but effective options before opting for a costlier drug. The drug utilization review is also a program run by Pharmacy Benefit Managers. The program aims to review the effectiveness, safety concerns, and potential dangers of a drug and alert their patients where potential negative drug concerns arise. They also provide feedback to employers to ensure that their members are receiving the best care possible and know where to make necessary improvements.

Pharmacy Benefit Managers make money through various means. One of these ways is by charging administrative and service fees from the insurance company for processing prescriptions, negotiations with the various drug companies and pharmacies, and managing mail-order pharmacies. They also generate revenue by collecting rebates from the manufacturer.

“Spread pricing” is also common among pharmacy benefit managers. They sell the prescription drugs to the payers at a higher price than they negotiated from the manufacturer and keep the difference in price as profit. Since PBMs do not traditionally disclose the prices they negotiate, they can sell at a public list price. Many believe that this negatively impacts the pharmaceutical industry as while drug costs are increasing, pharmacy reimbursements continue to decline. The situation forces drug companies to raise their product list prices.

The PBM industry faces some criticisms and is often a target for lawsuits and investigations by the government. In a bid to regulate PBMs, policymakers have proposed some reforms. One of these is by ensuring greater transparency around rebates by gaining more data to understand the necessary processes and know where changes are needed. Lawmakers also intend to ban the practice of spread pricing to ensure that prescription drugs are not overpriced for payers. Experts also advise that PBMs focus their business model on patient formularies, ensuring better access to cost-effective medical solutions.

Julius Winfield Erving II was born in Long Island, New York, on February 22, 1950. He spent most of his formative years in New York and attended Roosevelt High School. Erving began to flourish on their basketball team and earned the nickname “Doctor Julius” or “Dr. J.” He left high school in 1968 to enroll at the University of Massachusetts Amherst.

While in Massachusetts, Erving’s basketball gameplay improved tremendously. He was known for using his 6-foot 7-inch powerful frame to garner numerous dunks, blocks, and rebounds every game. He played for two seasons and left in his senior year with an average of 32 points and 20 rebounds per game.

After leaving college in 1971, Erving joined the Virginia Squires as an undrafted free agent in the American Basketball Association (ABA). His unique play style saw him average 27 points per game and earned him spots on the ABA All-Rookie Team and the All-ABA Second Team.

After a fantastic rookie season, the Milwaukee Bucks drafted Erving as the 12th pick of the NBA drafts. He was, however, locked in contractual disputes with the NBA after signing a contract and training with the Atlanta Hawks instead. During this dispute, the NBA banned him from playing in their league after the ABA filed a petition to that effect.

Erving played a further season with the Squires on his return to the ABA before leaving for the New York Nets. While playing for the Nets, he won the Most Valuable Player (MVP) award for three consecutive years between 1974 and 1976. He also led them to two ABA Championship wins in those years. Erving eventually finished his ABA career with three scoring champion titles and an outstanding record of 11,000+ points.

After the ABA’s dissolution into the NBA, the Nets sold Erving to the Philadelphia 76ers for a fee of $3 million. His quick, high-flying, and athletic dunking styles quickly captured the hearts of fans, and he rapidly became recognized as one of the league’s best players. He led the 76ers to the playoff finals in his first season, beating the Boston Celtics in the Eastern Conference finals. He, however, could not secure the championship as they came up short to the Portland Trail Blazers in six games.

In 1979, after two unsuccessful playoff runs, Erving again led his team to the Eastern Conference Finals, where they lost to Larry Bird and the Celtics. The game saw the beginning of the Erving and Bird rivalry, one of the most defining rivalries in NBA history. In 1980, Erving and the 76ers prevailed over Bird and the Celtics in the Eastern Conference, but they again could not secure the championship after losing to the Los Angeles Lakers in the finals. Erving performed a stunning mid-air move by drifting away from defenders and scooping the ball into the net. This iconic play was later named the “Baseline Move.”

In 1982, Erving again led his team to the finals, picking up his first and only NBA MVP title. They again lost to the Lakers in a thrilling six-game series. The following season, the city of Philadelphia rallied behind Erving and the bolstered team as they secured a 65-17 regular-season record. They went on to the finals and, this time, prevailed by sweeping the Lakers to secure their first and most recent NBA Championship title.

Erving announced that he would retire at the end of the 1986-87 season, resulting in a sell-out crowd for every 76ers game. He was an NBA All-Star every season he played in the league, and he ended his playing career with an average of 22 points per game. In 1993, he was the headline inductee into the Basketball Hall of Fame as one of the most influential players in history.

The longest-standing point-of-care pharmaceutical dispensing company, DispenseDoc, was launched after its owner learned that one in three prescriptions go unfilled at pharmacies. Convenience and cost were cited as two primary reasons that this happens. To address this gap in drug dispensing, DispenseDoc created a platform that builds long-term relationships with physician practice partners to make dispensing prescriptions more convenient and cost-effective.

DispenseDoc built these relationships through its service menu. Its service menu feeds into the pharmaceutical dispensing firm’s three programs for patients. The firm offers three methods for physicians and patients to dispense and receive their medications: the Pharmacy Benefit Managers program (PBM), its workman’s compensation program, and the cash-and-carry program.

The PBM program for private insurers allows patients to pay for their prescriptions through insurance reimbursements. The patient’s physician’s office or medical office collects the copay, and then sends reimbursement information to the insurance company.

In cases of workman’s compensation, DispenseDoc’s partnership with healthcare providers makes dispensing prescriptions and collecting reimbursements easier for physicians. Through this partnership, physicians dispense patient medications at the point-of-care office and DispenseDoc works directly with the Workers Comp insurers to cover the medications.

Finally, patients also come by their medications through a cash and carry system that allows them to pay for their medications at the point of care at a typically lower out of pocket cost than the pharmacy.

Regardless of the platform patients use, this seamless, streamlined system occurs because of the services DispenseDoc offers to its partners, point-of-care dispensing. On a typical office visit, patients see their doctor, travel to the pharmacy, and wait for their prescriptions to be filled.

DispenseDoc cuts out at least two time-consuming steps, travel to the pharmacy and the wait for the prescriptions to be filled. It does this by making it possible for patients to pick up their meds through one of the abovementioned means.

In addition, patients benefit from this streamlined approach to prescription dispensing. Patients can ask questions about their meds while at the office, making it more likely for them to follow and understand the physician’s directions. Further, physicians benefit from the fact that patients are more likely to pick up their prescriptions if they only have to make one trip.

When a healthcare provider decides to partner with DispenseDoc, the point-of-care pharmaceutical company makes sure the provider is operating within the margins of state laws and requirements. In addition to making sure that the medical office has the correct documents to dispense drugs from the office, DispenseDoc also works with more than 40 PBMs to provide detailed status updates and information on the next steps in the process.

This credentialing extends to providing healthcare providers with detailed training. The training offered includes reviewing patient eligibility, managing dispenses, tracking inventory, and settling patient insurance reimbursement.

This training includes becoming familiar with DispenseDoc’s web-based software. This tool allows medical offices to order, track, manage, and dispense medications from any computer, in addition to printing prescription labels.

As a part of the web-based program, the medical office receives notifications related to low inventory medication counts and information related to drugs that are about to expire. Additionally, DispenseDoc’s account managers work with healthcare providers to review medications available in the firm’s list of medications. The firm also routinely reviews new medications that DispenseDoc wholesalers provide and gives this information to their physician partners.

Finally, this web-based system provides physicians with a centralized store for extracting data on each prescription that is dispensed. Located in its billing system, the data is taken from information generated from the insurance claim submitted to the insurance carrier.

Using this information, each medical office is provided invoices for that calendar month. DispenseDoc also provides medical offices with assistance in reconciling dispensing costs and insurance reimbursements.

Point-of-care medication dispensing addresses the many flaws in the current way patients pick up their medication. Point-of-care pharmaceutical dispensing refers to a system of dispensing medication on-site or nearby the medical/physician’s office. Point-of-care drug dispensing also saves patients an extra trip.

Beyond being very convenient, point-of-care pharmaceutical dispensing has various advantages. Point-of-care solutions can come in one of three formats. The in-house pharmacy offers patients access to a pharmacy in the same building as the medical/physician’s office from which they receive their care and contains a pharmacist onsite.

The other two types of point-of-care formats are the pharmacy kiosk and the dispensary. The kiosk dispenses drugs through a free-standing prescription dispensing machine, and patients communicate with a remote pharmacist through a phone receiver and a monitor.

Finally, the dispensary style of point-of-care medication dispensing is a small pharmacy located in a brick-and-mortar building located onsite and that functions through a physician/clinic-dispensing model. Moreover, this style does not include an on-site pharmacist.

Regardless of the format, one of the immediate advantages is that the pharmacy services’ proximity gives patients immediate access to their medication. When the physician is close by, the doctor can explain the medication (including side effects), discuss how it should be used, and address any concerns their patient might have. Finally, it is an opportunity for patients to ask the doctor questions.

Point-of-care dispensing also has benefits in generating income. Patients are more likely to get their prescriptions re-filled at a point-of-care facility if they have a good experience, which includes convenient access to personalized service.

Outside of personalized service as a draw for patients returning to get their medication refilled, some experts state a physician can increase earnings without having to increase the patient load. Depending on the type of point-of-care format used for dispensing medications, dispensing medications in or near the physician’s/medical office can translate into extra earnings between $50,000 and $200,000.

Additionally, point-of-care medication dispensing opens up retail opportunities for physicians in terms of providing ancillary services. Ancillary retail services usually involve selling medical products, for example, eyeglasses, to patients.

In terms of patient safety, point-of-care prescription dispensing reduces the chance that patients make mistakes due to harmful drug interactions when taking their medications. One figure estimates that 70 percent of pharmacies fail to explain how prescribed drugs should be taken resulting in harmful drug interactions.

Point-of-care dispensaries, alternatively, dispense drugs in prepackaged medications that provide clear drug interaction information. In addition, the physician can print other drug interaction information to give to the patient from the software the point-of-care provider gives to the physician’s office.

Furthermore, this style of dispensing prevents patients who are taking more than one drug from mixing up their medications. Because the medications are prepackaged, pills are stored separately in pouches according to the way the manufacturer packages them.

Also, prepackaged medications cut down on cross-contamination. From the pharmacy to the patient, many people handle medications while preparing them. Both pharmacy technicians and pharmacists can pass germs onto the medications, which is prevented when the drugs are prepackaged. Further, prepackaging companies have to follow rigid state and federal guidelines regarding cleanliness, reducing the incidence of contamination.

Ultimately, point-of-care drug dispensing also translates into a streamlined, more efficient office with office staff only needing to learn how to use the point-of-care software the company provides the medical office.

Usually, prescriptions are filled through a web portal, which allows the medical office to send claims at the same time. For example, these web portals make filing worker’s compensation and billing a lot simpler.