Managed Care - August 2012 - (Page 37)

Key PBM Functional Areas Require Radical Transformation In large part, the growth of specialty pharmacy will require pharmacy benefit managers to become more active on behalf of payers and patients T By Warren K. Williams he advent of the Medicare Part D program in January 2006 along with other government initiatives has commoditized the traditional pharmacy benefit management (PBM) business model. Forcing transparency and openness into the business model was either good or bad, depending on your perspective and your reality. Regardless, the industry is radically transforming certain areas of its business to become innovative in ways that may blur the lines between health plans and PBMs. For example, in order to manage a patient’s complete medical history, health plans will require timely information about what drugs are currently prescribed and PBMs will require timely access to medical history to ensure that the most effective drugs are being prescribed. While the current pricing model may leave little room for negotiation, innovative management programs within specialty pharmacy will provide opportunities for health plan physicians and pharmacists to create evidence-based protocols and develop new adherence models in partnership with the home health market and pharmaceutical industries. This is the PBM industry’s magic formula for potentially huge new sources of revenues. Six functions In the next few years, there will be six key internal functions within the PBM organization that will require transformation and organizational change: sales and marketing, prescription processing, pharmaceutical company relationships, specialty pharmacy, product/service pricing, and customer service. PBM sales and marketing must meet the demands Pharma Employer groups Health plans PBMs Pharmacy Providers Patient Pharma Employer groups Health plans Patients AUGUST 2012 / MANAGED CARE PBMs Tranformation process Pharmacy Providers 37

Table of Contents for the Digital Edition of Managed Care - August 2012

Managed Care - August 2012
Editor’s Memo
Legislation & Regulation
News & Commentary
Medication Management
Evidence Review
Compensation Monitor
Private Exchanges: Practice Makes Perfect
Hospitals and Providers Ganging Up on Plans?
Q&A: Kaiser Permanente’s Sharon Levine, MD
God Save the Health Care System!
Future Points to Greater PBM/Plan Cooperation
Formulary Files
Plan Watch
Tomorrow’s Medicine

Managed Care - August 2012