Becoming a Stronger Advocate: How Biologic Coordinators can lead the fight for dermatology access

Jul 1, 2025

Becoming a Stronger Advocate:How Biologic Coordinators Can Lead the Fight for Dermatology Access
By Alisa Redmon

Every day, biologic coordinators across the country are on the front lines of patient care—battling denials, negotiating with payers, and navigating the maze of prior authorizations to ensure patients get the life-changing medications they need. The impact is real. We’re making a difference—one approval, one appeal, one patient at a time.

But the truth is, the problem runs deeper, and it's time we step up not only as care navigators—but as advocates.

The PBM Problem: What We’re Up Against

Pharmacy Benefit Managers (PBMs) are some of the most powerful yet opaque players in our healthcare system. They control drug formularies, determine what medications are “covered,” and funnel patients into affiliated specialty pharmacies—all while profiting at the expense of patients, independent providers, and local pharmacies.

Instead of prioritizing affordability or access, PBMs often favor drugs that bring higher rebates, not better outcomes. They:

Mandate the use of preferred or in-network pharmacies
Penalize patients who seek outside options
Impose contract terms that cripple independent pharmacies
Limit generic options in favor of higher-priced brand names

And the result? Patients are forced to choose between their medication and their livelihood.

The Numbers Don’t Lie

In 2024, the Federal Trade Commission (FTC) released an interim report confirming that six companies dominate nearly 95% of the U.S. pharmacy benefit market:

CVS Caremark
Express Scripts (Cigna)
OptumRx (UnitedHealthcare)
Humana
MedImpact
Prime Therapeutics

Of these, the top three account for 70% of all specialty drug revenue. The reach is massive—and so is the need for reform.

Legislative Momentum: PBM Reform Is Gaining Ground

The PBM crisis is no longer a secret. Legislators across the U.S. have introduced bipartisan legislation to rein in PBM practices and prioritize transparency and patient access.

🏛️ H.R. 9096 – The Pharmacists Fight Back Act

Introduced in July 2024 by Rep. Jake Auchincloss [MA], this bill seeks to:

Prohibit PBM steering and spread pricing
Ban forced use of in-network pharmacies
Prevent PBMs from reimbursing less than what patients pay
Protect access to generics over more expensive brands
Stop retroactive claim adjustments
Ban anti-reimbursement practices against pharmacies

Violating this act would be considered a felony, carrying up to $1 million per violation or 10 years in prison. It also allows civil action by patients—finally giving the public a chance to fight back.

This is historic. For the first time, there’s real potential for PBMs to be held accountable. But legislation doesn’t pass itself. It requires pressure—and that’s where we come in.

Where BCs Can Lead: From Access Champions to Policy Advocates

We are the ones doing this work every day. No one understands the impact of PBM abuse like we do. And while we’re fighting case-by-case battles in the office, we also need to fight system-wide. Here's how:

🔎 1. Stay Informed

Track PBM-related legislation in your state
Follow advocacy groups like the NCPA, TruthRx, and PatientProtector.us

📣 2. Raise Your Voice

Contact your state and federal representatives
Share why PBM reform matters and urge support of active bills.
Use this easy complaint form from NCPA: NCPA PBM Complaints Tool

📝 3. File Grievances

Don't let unfair practices slide. File complaints with:

Your State Department of Insurance
CMS
State Boards of Pharmacy
State Departments of Health or Commerce
Federal Trade Commission (FTC)
Tricare, if applicable

🙋‍♀️ 4. Empower Patients to Speak Up

Encourage patients to file complaints with their employers or insurance plans
Direct them to share their stories at: PatientProtector.us

🧠 5. Share Your Professional Story

Lawmakers need to hear from us—the ones managing authorizations, access delays, and denials daily.

📢 Add your voice: Share Your PBM Horror Story

Final Thoughts: We’re Already the Experts—Now Let’s Be the Advocates

As Biologic Coordinators, we already understand the barriers. We already see the harm. We already know how to navigate the system better than anyone else.

Now is the time to get louder, organize, and demand better—for our patients, our practices, and the future of dermatology care.

The fight against PBM abuse starts with us—and we’re not alone.

🔗 Resources:

📧 Need help or training for your office? Contact us at Biologics@bceducators.com

💡 Want more dermatology and patient access insights? Subscribe to the BC Insider Newsletter for expert tips and resources! 🚀

At BC Educators, we are dedicated to empowering biologic coordinators, healthcare professionals, and patient advocates with the education, tools, and resources needed to optimize patient care. From expert-led webinars to hands-on training, we provide comprehensive support to help you navigate the ever-evolving landscape of specialty medications and prior authorizations.