Pharmacy Benefits Need to Change—Here’s How

Dr. Helen Sherman is Executive Vice
President & Chief Pharmacy Officer at WithMe Health.

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When I started my career as a pharmacist over 20 years ago, the pharmaceutical industry was radically different. Medications were relatively simple, one-size-fits-all, and significantly less expensive compared to today.

Now we have high-cost complex biologics, genetic-specific targeted medications, treatments for rare conditions—even treatments created for a single individual using their own cells.

The medication landscape is in the midst of a transformation, yet a critical part of the industry—pharmacy benefits management—has not changed. Legacy pharmacy benefit managers (PBMs) were founded decades ago to consolidate buying power, driven by using medication volume as leverage.

We need a new model. As other industries have moved towards transparency, PBMs remain opaque, with complex business models that benefit from high volumes of medications and high-cost medications, whether or not anyone gets better.

Many people aren’t getting the right medications, and of those that do start the right treatment, they often pay too much or don’t take them correctly. All of these problems and others end up costing more down the road. The employers who pay for their employees’ plans have little or no visibility into where the money’s going or whether medications are working as costs continue to rise.

It’s time for this to change—and that’s why we founded WithMe Health. We’re building a new model, called Personalized Medication Guidance.

Our evidence-based medication review considers all relevant data, including medical, pharmacy and lab information, and creates a customized medication plan for each individual to produce the best possible outcomes.

Our support team of expert pharmacists and guides, available 24/7 via app or phone, provides proactive clinical counsel before, during and after treatment. Our goal is to ensure people are taking the right medication, at the right dose, at the right time.

We’re working with stakeholders across the industry to realign incentives to focus on positive outcomes—getting people healthier, reducing unnecessary costs and providing the best possible experience.

It won’t be easy to change the current entrenched system. But we’ve got a team of dedicated people who know the industry and know what we need to do, and we’re well on our way.

We look forward to a day in the near future when pharmacy benefits management is known as an industry that helps people, and helps them get better.

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About the Author

Dr. Helen Sherman is Executive Vice President & Chief Pharmacy Officer at WithMe Health. With more than 25 years in the healthcare industry as a practicing pharmacist, clinician, pharmacy consultant and healthcare services leader, she is committed to advancing the best use of medications through using solid scientific evidence as the foundation for healthcare decisions. Helen holds a Bachelor of Science in Pharmacy from Oregon State University, a Doctor of Pharmacy from Purdue University, a Residency Certificate at Legacy Good Samaritan Hospital in Portland, Oregon and a Fellowship Certificate at State University of New York at Buffalo.