Pharmacy Benefit Manager Market Continues to Evolve

Pharmacy Benefit Manager Market Continues to Evolve. Recent consolidation in the pharmacy benefit manager (PBM) industry has resulted in major market share divided by the three market leaders: Express Scripts, CVS Health (Caremark), and OptumRx (UnitedHealth Group).

PBMs remain searching for a value proposition beyond drug distribution with their employer clients. As long as PBMs don’t take part in the financial risk of patient care their role and value proposition will continue to diminish.

Most pharmacy benefit designs remain similar to pre-ACA designs and slow to respond to the market changes underway. The larger a PBM the more issues with timely, effective service have been reported by patients, providers, payers and purchasers.

As payers and purchasers continue to focus more on patient outcome measures, PBMs as they have been know historically, will continue to be marginalized.

Over the past few years, a wide range of healthcare industry stakeholders, including health insurers and drug chains, are looking to leverage disruptive technology. The pharmacy benefit manager market is slowly becoming the target for these types of companies who see room to grow as the market seeks to deliver cost savings and efficiencies.

Health insurers have realized that they can leverage access to their established physician network. Employers have also realized that they can influence the medical and drug costs of their employees as risk-sharing models become more available.

Specialty drug spending has been the driving force highlighting the pharmacy benefit management function. Specialty drugs will continue to be a cost driver to PBMs impacting their clients and causing market disruption driven by large employers or purchasing coalitions.

Specialty drugs will continue to be a marketing theme by PBMs to their health plan and self-funded ASO clients.

The PBM model focused on volume-based strategies will evolve as market participants focus on the implementation of clinical programs in collaboration with payers and employers.