In my family’s native Cuba, pharmacy was the family profession. For five generations, members of the Dominguez family dedicated their careers to helping people get the medicines they need to live full, healthy lives.
By the time I was born, the Dominguezes had left Cuba for Southern California. Still, our family’s passion for pharmacy endured – I grew up watching my grandfather, father and uncle work behind the pharmacy counter. As I grew older, I chose to answer the same calling; I’m now in my tenth year as a pharmacist.
Today, I work as a Clinical Pharmacist for CVS Health. In this role, I serve as a patient advocate, acting as a link between patients and their doctors, simplifying the pharmacy experience and helping patients access the medications they need.
I closely review patients’ charts, working to ensure that if a patient needs a specialty drug – like those used to treat rare or chronic conditions like rheumatoid arthritis, cancer, HIV, or multiple sclerosis – they are able to get it. The most rewarding part of my job is when I get to inform a patient that their prescription has been approved and they will be paying drastically less than expected for their life-saving medication.
This work requires significant clinical expertise. For example, if a patient is prescribed a brand drug with a very high price, we help determine if a clinically equivalent biosimilar at a lower price is right for them. I also get a close-up look at the crucial role pharmacy benefit managers play in helping patients manage rising drug costs.
Big drug companies regularly set sky-high list prices for specialty medications. These sticker prices often cost patients upwards of $200,000 per year. These prices are unaffordable for far too many families here in California.
Thankfully, pharmacy benefit managers (PBMs) go head-to-head with drug manufacturers to negotiate the lowest possible prices on behalf of our customers. In 2022, CVS Caremark – the PBM of CVS Health – held overall prescription drug cost growth for our clients to 5.3 percent, the sixth year in a row we’ve kept this drug trend to single digits.
At Caremark, we’re especially proud of our work with labor unions. Many unions rely on PBMs to help them create quality, affordable prescription drug benefit plans that work best for their members.
Unfortunately, legislation currently under consideration in the State Legislature could put PBMs’ cost-controlling work in jeopardy. AB 913 (Petrie-Norris) would increase costs for unions and employers who provide pharmacy benefits – as well as the patients who rely on those benefits – and do nothing to lower those out-of-control drug prices set by big drug companies.
Some provisions contained in AB 913 would effectively eliminate many of the mechanisms that keep health care coverage affordable, causing care disruptions and pushing costs higher for unions, employers and employees. For instance, the bill could make it more difficult for unions and small businesses to contract with less-expensive pharmacies. It could even prevent those employers from being able to tell patients where to access more-affordable prescriptions.
In my job, I see where the rubber meets the road when it comes to prescription drug affordability – and how this process could easily be disrupted by misguided legislation which fails to address the root causes of drug costs: the high prices set by manufacturers.
When I get to utilize CVS Health’s PBM negotiating power and deliver good news about the out-of-pocket cost of a critically needed drug, the relief from my patients is palpable. I can sense their worry being washed away.
Those moments – where I’m able to instill hope in people struggling with medical issues – are exactly why I became a pharmacist. And those conversations are why, I imagine, my ancestors chose this same career all those generations ago.
Derek Dominguez, PharmD, is a Clinical Pharmacist for CVS Health in Lake Forest.
