American Health Leader recently sat down with EnvisionRx President of Commercial and Managed Care Markets Matt Gibbs, PharmD, and asked him about the challenges health plans face today. From rising drug costs and a pipeline full of costly specialty medications to new alliances tying more pharmacy benefit managers (PBMs) to health plans, pharmacy benefits has become more complicated.
According to Gibbs, PBMs have come a long way in improving the healthcare industry, and can help health plans gain control of the full pharmacy care experience. Because of their buying power, PBMs negotiate better pricing from pharmacies and manufacturers on behalf of plan sponsors and members. Additionally, PBMs with deep clinical expertise are able to design formularies that offer lower cost alternative medications with equivalent therapeutic value. They also manage drug utilization at the individual patient level, ensuring each patient gets the right drug, at the right time, with the right support needed to improve health outcomes.
For today’s health plan, the PBM can be a valuable resource to better understand the drug pipeline and how to manage costs and improve patient outcomes. Concerns arise when it is unclear how much a PBM charges plan sponsors for a drug versus what the PBM pays. Plan sponsors looking for alternatives to the one-size-fits-all approach has led to more health plans considering insourcing or co-sourcing the management of their pharmacy benefits for customized solutions. Health plans can gain more control, more transparency into claims and data, and better value as the PBM provides savings through efficiencies. However, it takes the flexibility of a PBM partner, like EnvisionRx, to be successful.
In the article, Gibbs provides a look at the role of the PBM and how the right partner can provide the flexibility and customization health plans need in the ever-changing pharmacy benefit marketplace. Read the article here.