Drettwan Jacob J, Kjos Andrea L
College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311, USA.
Pharmacy (Basel). 2019 Jun 14;7(2):65. doi: 10.3390/pharmacy7020065.
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.
与药品及相关利益相关者有关的高昂成本正在接受密切评估，以寻求解决方案。作为美国药品市场的主要利益相关者，药品福利管理（PBM）组织的做法受到了越来越多的审查。有争议的做法包括通过激励措施影响药品处方集地位，以及禁止药剂师透露低成本处方替代方案的信息。在关于这些组织在医疗保健系统中责任的辩论中，伦理调查在很大程度上被忽视了。基于组织做法在医疗保健服务过程中的潜在影响，对其进行伦理分析是合理的。本研究的目的是使用多种伦理决策模型分析PBM的几种具体做法，以确定其伦理性质。本研究系统地将多种伦理决策模型和道德准则应用于与制药环境中遇到的PBM相关困境有关的各种做法。评估的情景产生了不同的结果。根据所应用的伦理模型，PBM的做法既有符合伦理的，也有不符合伦理的。尽管不同模型之间存在差异，但有些做法主要是符合伦理或不符合伦理的。销售点回扣一直被判定为符合伦理，而市场整合、限制条款和药房报销波动则都主要被判定为不符合伦理。使用提供者道德准则进行的分析产生了更多的比较，结果也好坏参半。本研究对PBM的做法进行了独特的评估，并从各种伦理角度提供了背景信息。据作者所知，这些观点此前尚未在文献中应用于PBM的做法。伦理决策模型的应用为当前的医疗保健困境提供了独特的背景。使用基于伦理的框架分析医疗保健困境，对于提出解决医疗保健环境中所有利益相关者的复杂性和价值观的方案非常重要。
