PBM-Payer Partnerships: Insights into Alternative Cost Management Strategies

Sep 26, 2022

Orlando, FL – Last week at the 2022 PBMI Annual National Conference, Nicole Bulochnik, MS, PharmD, BCPS, BCCCP, CRC (Vice President of Drug Pricing and Network Strategy) and Timothy Mizak, PharmD, MS, MBA (Director of Drug Trend Solutions), presented on the topic of, “PBM-Payer Partnerships: Insights into Alternative Cost Management Strategies Across Common PBM Levers.”

The cost of specialty medications continues to rise. With a growing pipeline of specialty drugs and newer therapies costing in excess of $100,000 for a single course of treatment, a handful of claims can significantly impact a plan’s financial performance and stability. 

At the same time, utilization of specialty drugs, particularly those treating cancer and autoimmune conditions, is also increasing. In this climate, plans need a new approach and a PBM partner that is fully aligned with their goals and invested in helping them navigate this complex and uncertain environment.

In their presentation, Nicole and Timothy examined the current challenges health plans are facing around drug spending, discussing both the traditional and alternative (value-based) approaches that PBMs leverage to manage this critical piece of pharmacy benefits. In addition, they reviewed the strategies that are emerging to improve the process. 

The presentation covered topics such as:

  • The cost savings levers used to control drug trend.
  • Traditional and alternative pricing models and strategies that can help plans manage drug spend.
  • Comparisons between the different pricing models and their associated risks and benefits
  • The types of risk-sharing arrangements that PBMS can implement if they want partnerships with Payers/health plans, versus a standard vendor-client relationship.

If you weren’t able to attend the session in person, don’t worry – you can access the entire presentation here: Abarca Health-PBM-Payer Partnerships: Insights Into Alternative Cost Management Strategies Across Common PBM Levers


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