Changes are happening in the PBM market. Traditional services offered by PBMs will be supplanted by new PBM entities that will develop formularies among the services they offer. The new entity PBMs manage and supplement PBM services as an advocate for health care payers.
Services include prescription claims analysis and consultation, drug coverage management, PBM contracts review and consultation, PBM procurement management, specialty/bio-technology pharmacy services, and customized formulary design and management.
PBMs do negotiate rebates with drug manufacturers, and some portion of those rebates is passed along to the consumers. But the rebate system contributes to the rise in prices year to year. The rebates are coming out of those ever-higher prices, turning the downward pressure PBMs supposedly exert on prices into something of a mirage.
New entity PBMs provide clients with a comprehensive suite of sophisticated, informatics-powered, evidence-based clinical tools that meaningfully reduce the cost and improve the quality of their pharmacy benefits for both the payer and their members.
With the growth of new entity PBMs, what will become of the PBM as we know it today?
Give Dr. Randy Vogenberg or John Santilli a call to discuss the growth of new entity PBMs and their impact on the current PBM model and what it means for the different healthcare stakeholders