The PBM unbundling has begun: How Blue Shield of California and others are embracing new models

Recently, major health insurer Blue Shield of California announced it would drop its traditional pharmacy benefit manager (PBM) and instead partner with innovative companies to save $500 million overall when offering its 4.8 million members pharmacy benefits. This news represents a major shift in the health care landscape. Finally, the unbundling and disintegration of the PBM market has a path forward to unlock the value that ultimately belongs to those who need the medication.  

Many have questioned why Blue Shield of California is staying on with CVS Caremark for Specialty Drugs, which account for 49% of total pharmacy costs for U.S. employers by one estimate. The fact is, all PBMs must rely on multiple specialty pharmacies because there’s not one single pharmacy that can supply all specialty drugs. For specialty, a network will always be needed. 

However, it’s still laudable that Blue Shield of California is taking a stance on what the future of pharmacy benefits could look like. Here’s the question I have: How are the entities going to talk to each other so that the employee-member knows where to go for what, and coordinate across the system?