Pharmacy benefits: Setting the stage for 2019

Despite claims to the contrary, the majority of today’s PBMs use near-identical methods for controlling drug spends and reporting value to their clients. Will that change in 2019? (Image: Shutterstock)

Hard to believe, but we are in the final stretches of yet another year. That means most of us are beginning to think about the new year, what changes might be in store, and what can we expect. While these points as they relate to pharmacy benefits will be addressed in my next article, but first, I’ll set it up by discussing what we saw in 2018 and how it might impact the year ahead.

In the years leading up to 2018, consolidation or horizontal integration across pharmacy benefit managers (PBMs) was a major driver of change. Competition was whittled down to a few, select jumbo carve-out PBM providers that wield enormous buying power and influence throughout the entire pharmacy supply chain. Individually and collectively, they created a paradigm shift in which plan sponsors began abdicating control to the PBM for oversight of the pharmacy program (including allowing drugs to be excluded from the formulary, accepting required step therapies/prior authorization, and more frequent formulary changes).