Although pharmaceutical consulting has existed for only about 20 years, it has arguably shaped the landscape of medical care in the U.S. more than almost any other administrative function. Yet surprisingly, few consumers are aware of the day-to-day decisions that firms make on their behalf. Here’s a behind-the-scenes consumer’s guide to pharmaceutical consulting.
What it is: Pharmaceutical consulting is a process through which specialized firms help companies and health-care providers reduce the cost of prescription medication. The methods vary widely, from limiting the types of medications that are covered by insurers, to analyzing administrative processes and recommending improvements in efficiency.
Why consumers should care: Consulting firms can help reduce the cost of prescriptions, which may translate into slightly lower health-insurance premiums for consumers. But in some cases, firms may also make recommendations that reduce consumers’ access to some prescription medications. On occasion, these firms may even interact with doctors and directly influence which drugs they prescribe, and under what conditions.
How consumers can be better informed: Even if you don’t think your health-care insurer is limiting your access to certain medications, it’s still a good idea to call your health plan’s customer service number and inquire about their “fomulary restrictions.” Some insurers deny all “out-of-formulary” medications, for instance, while others allow them with an added surcharge.
Knowing your insurer’s rules-and to what extent they’re influenced by pharmaceutical consulting firms-can help you be a more informed consumer. By arming yourself with some knowledge about your prescription benefits, you’ll be able to be a better advocate for yourself, if you ever are denied access to a prescribed medication down the road.