TEXAS MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution 401 (A-06)
Subject: Preauthorizations Required by Commercial PBMs
Introduced by: Harris County Medical Society
Referred to: Reference Committee on Socioeconomics
Whereas, Many insurance plans have outsourced the management of prescription drugs to Pharmacy Benefit Managers (PBMs) as a way to control costs, particularly for nonformulary drugs; and
Whereas, PBMs routinely require physicians to complete an often arduous preauthorization process for patients before they will authorize payment to the pharmacy under this benefit plan; and
Whereas, Physicians receive no payment for the time spent on complying with this administrative burden imposed by PBMs and their patients receive no benefits until this process has been completed; and
Whereas, When the preauthorization process has been completed, PBMs often attempt to alter the prescription's dosage or duration, or substitute a generic in place of a brand name pharmaceutical for additional cost savings to the PBM; and
Whereas, Pharmacists have access to the plans' and the PBMs' formulary and could assist in sharing this administrative burden; therefore be it
RESOLVED, That the Texas Medical Association gather evidence of the administrative burden placed on physicians and patients by the policies and operating practices of Pharmacy Benefit Managers (PBMs) in order to document the impact on medical practices and determine whether the business practices of PBMs comply with state laws and regulations; and be it further
RESOLVED, That TMA explore the possibility of legislative action should no state laws or regulations apply to the preauthorization process required by PBMs.
TMA House of Delegates: TexMed 2006
Last Updated On
July 06, 2010
Originally Published On
March 23, 2010