Are we on track for Healthcare 2030?

Nov 30, 2023

At the first-ever Abarca Forward event, we discussed an outlined vision for what the healthcare industry would look like at the start of the next decade.

As we prepare for the new year, let’s check in and see if the industry has made any progress towards these predictions for Healthcare 2030.

Prediction: Convenient and affordable healthcare will begin with prescriptions

Status: Some progress

We can confidently say that we’re closer to achieving this goal than we could have imagined. Consumers are benefitting from several new ways to purchase and save on their medications. And the Inflation Reduction Act (IRA) made some meaningful changes for Medicare beneficiaries, including the introduction of a $35 price cap on insulin.

There is still significant work to be done to deliver a truly awesome experience for all consumers, but we are impressed and encouraged with the strides that have been made thus far.

Prediction: PBMs will cease to exist as we know them

Status: Headed in this direction

Healthcare organizations are showing more interest than ever in moving away from the traditional PBM model in favor of unbundled services. By integrating several best-in-class partners to manage their pharmacy benefits, this approach–which we call Virtual PBM–gives payers more flexibility and control. 

And while this model may not be ideal for every organization (for example, the contracting may be too complex for smaller, self-funded employers), it will create an overall shift in the relationships between PBMs, payers, and vendors.

Prediction: A farewell to rebate dependencies

Status: No change, but being closely monitored

As of now, there has been no meaningful change in the use of manufacturer rebates, but policymakers are looking at this issue closely. For example, under the proposed PBM Reform Act, PBMs would be required to pass 100% of rebates on to plan sponsors.

Given the role that rebates play in today’s healthcare ecosystem, untangling the industry’s dependence on them and finding suitable alternatives will take time. What’s important is finding the right solutions for payers and consumers and an orderly transition to a new, rational system.