Big changes are coming for the PBM industry, and we think it’s about time. Here are four key areas that could have a lasting impact:
- Rebates have always been a part of how PBMs do business—but these transactions as we know them may be coming to an end. The Trump Administration has introduced a proposed rule to eliminate the safe harbor protection that leads to these discounts, and while these amendments may only affect Medicare and Medicaid, they could be paving the way for changes for commercial health plans as well.
- Home delivery can be more convenient for members and, in some cases, may even improve adherence. Last year, Amazon acquired Pillpack, a full-service online pharmacy, signaling that bigger changes—and a better consumer experience—may be coming. Now, drug stores, plans, and PBMs are looking to step up their game.
- Drug prices in the US are at an all-time high, and everyone is taking notice. These price hikes aren’t just on breakthrough drugs either. Costs for some medications that have been on the market for decades are spiking too. While policymakers are considering ways to rein in drug costs, PBMs need to work with their clients to find new ways to manage spend—especially for specialty medications.
- Value-based contracts are becoming increasingly popular. These unique agreements are based on the premise that, if a drug doesn’t work as promised, the payer may be eligible for a rebate—or possibly a total refund. While many drug makers are taking a wait-and-see approach to value-based contracts, some have already started to put their money where their mouth is.
But this is just the beginning. New technology, and an increased emphasis on member engagement, for example, are also sparking innovation across the industry.
Abarca was founded to find a better way in healthcare, and we believe that the impending changes to how PBMs do business will help encourage the rest of the industry to join our pursuit.
This blog is based on a presentation that Jason Borschow, President & CEO of Abarca, created for an educational event hosted by Triple S.