PhRMA’s Post

Pharmacy Benefit Managers (PBMs) play a pivotal role in our healthcare system, acting as intermediaries between insurers, pharmacies, and manufacturers to manage prescription drug benefits. Their mission? To make medications more accessible and affordable for patients. With the complexity of drug pricing and reimbursement, PBMs have found themselves at the center of a heated debate. On one hand, they are seen as crucial players in negotiating discounts and rebates that can lower costs for insurers and consumers. On the other, questions arise about transparency, the impact on drug prices, and the overall effect on patient care. As we continue to navigate these challenges, it’s important to engage in open discussions about how PBMs can evolve to better serve all stakeholders. Collaboration, transparency, and patient-centric solutions must be at the forefront of this evolution. Together, we can work towards a healthcare system where every individual has access to the medications they need without the burden of excessive costs. 💡 How do you think PBMs can adapt to address the current challenges in healthcare? Share your thoughts! #Healthcare #PBM #PharmacyBenefitManagement #PatientCare #DrugPricing

U.S. pharmacy groups finally see results from their 15-year effort to raise awareness of the fact that the top three U.S. pharmacy benefits managers (who also own pharmacy chains, insurers and healthcare provider organizations) have deliberately inflated drug prices, limited patients’ access to medications and directly caused the closure of tens of thousands of community pharmacies. Says a Federal Trade Commission report: the PBMs “inflate prescription drug costs and interfere with patient care for their own financial benefit” and “have sought to use their position to artificially reduce reimbursement rates for competing pharmacies.” Read more here: https://lnkd.in/gyprmFtX

🚨New JAMA Viewpoint with by Nina Jain and Mallika L Mendu MD, MBA, FASN 🚨 “Misaligned Pharmacy Incentives in Value-Based Care” We discuss how rising prescription drug spending has been particularly challenging in the context of value-based contracts between payers and providers. This is partly due to confidential rebates, which create misaligned incentives between payers/PBMs and hospital administrators. 🔗 https://lnkd.in/dwzBT4WD

Pharmacists are a powerful piece of the #ClinicalTrial system and Syneos Health says anywhere from 20–40% of patients are lost between getting the prescription and filling it at the pharmacy. Download this overview on future strategies for bridging the gap. https://bit.ly/3Jv8Im4

For a nuanced and detailed look into potential PBM reform, we suggest reading this report. It reinforces the important work PBMs perform in negotiating drug costs for payers and patients, a role we understand firsthand as partners of several specialty PBMs. #Pharmacy #Healthtech #Healthcare https://lnkd.in/g5u5hGPg

Last week I posted regarding the negative impact pharmacy rebates can potentially have on company healthcare costs. One bucket within the rebate game that Pharmacy Benefit Managers exploit can be through formulary. PBM formularies may be designed to drive profit rather than focusing on clinical effectiveness. Embedded within your pharmacy contract may be terms & conditions allowing the PBM/Carrier to choose drugs for the formulary that are more expensive than non-formulary drugs and that this decision could be driven by rebates paid to the PBM/Carrier. Spoiler alert......this is happening quite frequently. In order to reduce costs to both your company and employees, it is critical that formulary options are reviewed to reduce inclusion of drugs for the purpose of inflating PBM profit.

The paper "A primer on brand-name prescription drug reimbursement in the US" provides an overview of the key players involved in the reimbursement process, including manufacturers, wholesalers, pharmacies, health care providers, patients, payers, PBMs, GPOs, and pharmacy service administrative organizations. It also discusses the flow of funds for drugs covered by the pharmacy and medical benefits, as well as future trends in the industry. via Healthcare Economist https://ift.tt/Yxa016f January 25, 2024 at 10:22AM #healthpolicy, #healthsystems, #policy

Read this case study to learn how we created an adjudication solution for a national specialty pharmacy that controlled costs and improved operations. #ThirdwaveRx #Healthtech https://lnkd.in/gjsYkjhT

The legacy PBM business model has long been rooted in the flawed assumption that pushing higher drug volumes equates to higher rebates and greater “savings” for plan sponsors. The fact is, however, that inflated rebate levels coupled with poor clinical management, do nothing to reduce drug costs or improve patient health outcomes. Now, there’s a breakthrough PBM model that’s proven to measurably improve patient health and well-being while slashing prescription drug spending for plan sponsors and lowering per-member/per-month costs. This clinically-driven pharmacy care approach starts with putting the pharmacist at the center of the PBM service model. The mission of clinically-driven pharmacy care is to make sure patients receive the right drugs, at the right time, at the right cost. How radical is that? Ready to transform your pharmacy benefits plan? Join us for EmpiRx Health’s exclusive webinar “The PMPM Trend is Now Your Friend!” *NEW DATE: Thursday, October 24th, 11 am EST.* Spaces are limited: Register Now. https://lnkd.in/gjuQ4TCS

I took on two different independent pharmacies as clients recently, both needing help to implement a 340B contract pharmacy relationship with a local covered identity. This relationship is not without risk for the contract pharmacy— The terms of the arrangement are important to get right. Properly implemented, these are synergistic relationships where an independent pharmacy is a true partner in caring for mutual patients. #340B #pharmacy #healthcare #340Bprogram #pharmacy #pharmacists https://lnkd.in/gQnR6imG