The pharmacy benefits landscape will continue to evolve and impact the future, and several unique perspectives will emerge in the next 18-24 months. (Image: Shutterstock)
Most who have been in the pharmacy benefits business for any length of time have learned that change, both real and perceived, is a constant. Perceived change is driven by marketing lingo and product positioning by organizations claiming new-to-market or revolutionary solutions, when in fact, the real measurable solution is still in the proof-of-concept phase.
Why does this matter? Right now, our industry is undergoing major restructuring that is purported to bring about great change, more control for plan sponsors, better control over the total health care spend, and increased visibility into medical and pharmacy costs. We will examine several market dynamics which are converging to mold the future of health care.
Vertical integration
Moving forward, PBM's historical value proposition will be overshadowed by the promise of managing total cost of care. Additionally, three of the top four specialty pharmacies that in total have roughly 75 percent market share will now be under common ownership with a health plan. It is expected that health plans will begin to more effectively leverage the specialty pharmacies distribution, aggressive management strategies, and rebating capabilities under the medical benefit as they seek to tackle total cost of care.
Prescriber engagement
Along with vertical integration will be a transformation in the way PBMs and health plans work with prescribers. Currently, too much of the drug benefit management happens after a patient walks out of the physician's office. Putting point-of-sales claim adjudication information at the fingertips of the physician at the point of prescribing will be a game changer, minimizing member disruption and creating an environment for more effective management of the drug benefit.
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