Pharmacy Benefit Industry Reports

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The pharmacy benefit management market is shifting from the traditional PBM business to an evolving model for the larger PBMs that will see them becoming more aligned with payers, focus on transparency, increase innovation in tools and services, negotiate new contracting models, and initiate an increasing number of mergers and acquisitions. Industry stakeholders will evolve while continuing to monitor Amazon’s activities.

Spotlight on PBMs: 2018 Annual Review

Spotlight on PBMs: 2018 Annual Review. AMI’s 2018 Annual Review of Pharmacy Benefit Managers (PBMs) finds participants under increasing scrutiny for the role they play in the high prices of drugs in today’s market.

Consolidation in the PBM market has resulted in a small number of larger players that are able to leverage their size for more negotiating power with insurers and drug makers. PBMs, commonly referred to middlemen in today’s market, have been able to obtain significant influence over pricing and competition.

Current PBMs are scrambling to develop strategies to succeed, health plans are creating in-house PBMs, IT based companies are eyeing small niches to compete, and new entries, especially Amazon, are beginning to surface.

Drug Rebate Aggregators and Checklist for Purchasers

In this era of high tech and big data, administrative surveillance of rebate programs by payers, aggregators and manufacturers has been enabled to unprecedented levels of micromanagement.  Purchasers of rebate aggregator services should not be an exception to this process. 

Painstaking though it may be, due diligence in the contracting process will yield dividends in the long run. It cannot be emphasized enough that electronic formulary and rebate management platforms are essential tools to maximizing rebate performance.  The amount of detail necessary to support informed decision making for formularies includes economic as well as clinical information. Having real world net cost information readily available is invaluable in the success of these programs.

With the growing interest in consumer point of service rebates, developing these capabilities to support client benefit options adds another important consideration to rebate revenues and the timeliness of funding needed to support these POS rebate programs.

The Rebate Aggregator Checklist is intended to provide an overview of information that may be relevant to your evaluation process. 

Mail Order Pharmacies Overview

Mail-order pharmacy use has been growing as consumers become comfortable shopping from home. Mail order dispensing growth in dollars has continued at the expense of other retail and mail alternatives since 2013. In the current turbulent pharmacy benefit management market, mail order pharmacy is playing an increasingly important role for major market participants.

Copay Accumulator Programs: 2019 Update

Industry stakeholders are all working to reduce health plan spend for specialty drugs. Copay accumulator programs were introduced in 2018 by pharmacy benefit managers and promoted to health plans and employers (plan sponsors).