Abstract
The high costs associated with pharmaceuticals and the accompanying stakeholders are being closely evaluated in the search for solutions. As a major stakeholder in the U.S. pharmaceutical market, the practices of pharmacy benefit manager (PBM) organizations have been under increased scrutiny. Examples of controversial practices have included incentives driving formulary status and prohibiting pharmacists from disclosing information on lower-cost prescription alternatives. Ethical investigations have been largely omitted within the debate on the responsibilities of these organizations in the health care system. Ethical analysis of organizational practices is justified based on the potential impact during health care delivery. The objective of this study was to analyze several specific PBM practices using multiple ethical decision-making models to determine their ethical nature. This study systematically applied multiple ethical decision-making models and codes of ethics to a variety of practices associated with PBM-related dilemmas encountered in the pharmaceutical environment. The assessed scenarios resulted in mixed outcomes. PBM practices were both ethical and unethical depending on the applied ethical model. Despite variation across applied models, some practices were predominately ethical or unethical. The point of sale rebates were consistently determined as ethical, whereas market consolidation, gag clauses, and fluctuation of pharmacy reimbursements were all predominantly determined as unethical. The application of using provider codes of ethics created additional comparison and also contained mixed findings. This study provided a unique assessment of PBM practices and provides context from a variety of ethical perspectives. To the knowledge of the authors, these perspectives have not been previously applied to PBM practices in the literature. The application of ethical decision-making models offers a unique context to current health care dilemmas. It is important to analyze health care dilemmas using ethics-based frameworks to contribute solutions addressing complexities and values of all stakeholders in the health care environment.
Highlights
States (U.S.) as well as the rest of the world for several decades [1]
The pharmacy benefit manager (PBM) practice that was most likely to be found ethical by the models included point of sale rebates
The results showed a novel assessment of ethically questionable PBM practices with mixed findings on their ethical nature
Summary
States (U.S.) as well as the rest of the world for several decades [1]. This issue has prompted vigorous discussion from a variety of stakeholders in the attempt to find agreeable solutions to a seemingly insolvable problem [2]. Discussions with experts and stakeholders have included government payers, health insurance organizations and pharmaceutical manufacturers. The most common frameworks considered in solutions are economic and legal rationales [3]. Economic defense of high costs often point towards the capitalistic free market and theory of supply and demand. Legal considerations rely on explanations related to intellectual property rights, patents, proprietary
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