I work at a PBM. That’s pretty hard to explain. What is it that I do exactly? I’m not really sure myself.

What’s the point of a PBM? Why is it necessary? It’s very much behind-the-scenes kind of work. The general public typically isn’t very aware of the existence of these rich, powerful, nearly invisible companies. They just don’t play an active role in the daily life of many people.

To many, I’m just the person at the other end of the phone. Faceless, but not entirely insignificant. In a very small way I help decide the fate of another human’s life. I will either approve coverage of their medications, or simply hand the request over to someone who may deny them.

I make $15.50 an hour doing this.

After work, I have just enough time to either go to the gym, or play free computer games and dissociate, wishing I was somewhere else, doing something else with my life.

I think this company’s role is a superfluous one. I’m pretty sure society would get along just fine without these PBMs: These companies that would buy medications at a hugely discounted price from drug companies (thereby forcing them to raise the price over time to try to make up for the loss), sell those drugs to insurance companies and patients for a price 1000 times higher than the original cost, and for kicks, also force patients to use the PBM's own particular pharmacy to buy those medications. And, on top of that, they are contracted with insurance companies to judge whether a prescribed medication will be covered or not.

Who benefits from PBMs? A single infusion with just one of these medications costs tens, sometimes hundreds of thousands of dollars. Some medications – millions. Where is all the money going?

I work for a vampire. An overpowered monster in the shadows leaching the money and life out of people. Perhaps, sometimes, turning those people into sort of embittered, pessimistic little monsters themselves. Struggling with their own physical illness, and now also struggling to pay for the treatment, they lash out at the pharmacy dispensing the medication. Or sometimes they will lash out at me on the phone. Or perhaps they may even lash out at their own friends and family in frustration. I don’t have a very noble profession.

I’m not high enough on the corporate food-chain to do jack squat about any of this though. Information flow is very restricted between different departments. Even my own supervisor is careful not to give the full picture about why we do or say things a certain way. Perhaps she doesn’t know herself. No single cog really knows what the other cogs are doing. The trade secret is so secret even the employees don’t really know what it is or how it all works. No one can afford to lose their job over it, so no one questions it too deeply. It’s all by design. And no one is allowed to speak with the grand architect.

I once had a caller who demanded to speak to the president of the company. He yelled in my ear threatening hell and high water with lawsuits because what we were doing is disgraceful. For these “escalations,” as we call them, we are trained only to transfer the callers to our immediate superiors. In my case, it would be the clinicians, who won’t do jack except maybe transfer them to their supervisor, who will either take a number and never call back, or just transfer them to their superior who may or may not transfer them to a department of the company that specializes in silencing these types of callers forever.

You can put up a fight if you want, but in the end you will be screwed over, and you will have wasted so much of your time just to get to that point.