The PBM industry is experiencing a confluence of technological, regulatory, and marketplace changes.
For many, this is both welcome and overdue. Organizations now have the opportunity to seize on this moment to spur an evolution in healthcare that will provide a better experience for everyone. To harness this momentum, organizations should:
- Embrace advanced technology. For years, leaders in the health and tech industries have hypothesized how AI can transform the healthcare experience. And while its potential is boundless, organizations need to hone in on the most valuable applications for this technology in pharmacy benefits. In particular, they should focus on increasing efficiencies, expanding the use of data, and improving the member experience.
- Empower pharmacies. Between administering COVID-19 vaccines, expanding prescribing capabilities in certain states, and other initiatives, pharmacies have consistently demonstrated their ability to make an impact on care delivery. Consumers also see their pharmacists more regularly than any other healthcare provider. Payors, regulators, and technology providers need to work together to champion pharmacists as they move beyond their traditional role and deliver more value for everyone and better care.
- Manage high-cost drugs. Specialty medications are already the biggest drivers of drug spend and, as more therapies receive approval, high-cost drugs will create even bigger strains in the coming years. Organizations can begin putting measures in place to get control of this trend before it spirals further. In particular, they should adopt new approaches for formularies and utilization management, embrace biosimilars, and forge a holistic approach to weight loss and diabetes management.
- Unbundle of PBM services. Adopting a Virtual PBM model gives plans greater visibility into their benefit programs as well as the ability to adopt modern technology to increase efficiency and reduce administrative costs. This new approach can also provide greater control and the ability to deliver a better member experience.
When combined, these actions will enable better use of technology across the industry, greater insights into member health, and a more efficient healthcare ecosystem.
In short, if the industry works together to embrace and accelerate the changing tides, we can usher in seamless and personalized healthcare for everyone.
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This blog was based on the presentation Jesse Ruzicka, our Senior Vice President of Sales, delivered at the 2024 PBMI National Conference.