APPROACHES TO NAVIGATING THE PHARMACY BENEFIT MANAGEMENT SPACE

 

America is facing a crisis with rising healthcare costs, especially when it comes to the costs of prescription drugs. Drug costs are skyrocketing—especially generic drugs whose costs logically could be expected to remain flat or even decrease. Although many factors contribute to rising healthcare costs, attention is beginning to focus on the largely hidden role played by pharmacy benefit managers (PBM).

 

Over the last three and a half decades, PBMs have expanded their behind-the-scenes role as claims administrators to become power players in a trillion-dollar industry. As prescription drug costs have risen, PBM earnings have greatly outpaced health insurers, retail pharmacies, and pharmaceutical wholesalers.

 

In this HealthLeaders Roundtable, the panel parses the major challenges to negotiating with PBMs, what legislative proposals at the state and federal level might offer meaningful relief, and what role PBMs will play in a value-based world.