Creating meaningful change in the PBM marketplace

The paradigm shift necessary to spur evolution in pharmacy benefit managers includes two key pillars: improving care coordination and infusing complete transparency into the system.

Today’s prescription drug landscape is complex. The FDA works constantly to review and approve new medications and expanded uses for existing medications. In 2018, the agency set a record for novel drug approvals–59, compared to a 10-year average of 33. That means more drugs to treat more ailments, each with its own risks and benefits. Physicians work hard to do what is best for their patients, but they cannot do it alone. Every medication they prescribe carries certain contraindications and risks. These can be challenging to identify when there are barriers to communication and coordination between each of a patient’s health care providers.

Pharmacy benefit managers (PBMs) are sometimes viewed as one of these barriers, but they don’t have to be. PBMs can support efficient coordination of care between prescribers, specialists and pharmacists. This coordination mitigates the risk of potentially harmful medication utilization, something that helps both patients and plan sponsors.