Ensuring PBMs Provide Value to Improve Care Management

April 15, 2022

Pharmacy benefit managers are ostensibly intended to help reduce drug costs for payers and patients, but the retail-like volume-based model of the industry stands in the way of this mission. To correct this, a value-oriented model must be adopted. In a new MedCity News article, author Karthik Ganesh explains the disconnect between PBMs, employers, and patients and examines the impacts a value-based approach to PBMs would alter the healthcare landscape.

According to Ganesh, “While most PBMs continue to focus on driving a drug pricing conversation, care management in the industry has continued to be archaic, condition-oriented, and organized around rebatability and the PBM’s bottom line. Relying on a strength in numbers mindset, PBMs have continued to add clinical programs for more conditions while refusing to do anything different around the health of client populations and their patients with complex care needs. Employers have also been conditioned to accept that the PBM is offering more clinical programs and hence must be doing its job. While this is happening, the underserved find themselves even more on an island than ever before. The perfect recipe for healthcare inequity.”

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