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Pharmacy Benefit Managers


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Pharmacy Benefit Managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS programs .

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Pharmacy Benefit Managers

  1. 1. PBMs REDUCING DRUG PRICES "Sarthak is a healthcare enthusiast who is passionate about the application of creative ideas to streamline the healthcare ecosys- tem and evaluate ways to minimize the costs involved. He has been involved with US healthcare for a few years now and loves to understand challenges of various stakehold- ers, impact of regulations on them and figure out ways to leverage technology that will impact business positively." Sarthak Thussu
  2. 2. Pharmacy Benefit Managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS programs with goals to lower prescription drug costs, improve convenience, and ensure patient safety for payers and their benefi- ciaries. PBMs may provide significant advantages to payers looking to lower prescription drug prices. Payers in both private and public sectors require new strategies that offset rising cost of prescription drugs. As healthcare payers seek effective ways to manage high prescription prices, PBMs can maximize the Return on Investment while improving beneficiary satisfaction. PBMs reduce prescription drug costs and improve quality for patients, employers, unions, and government programs by: Engaging patients to make better health decisions and maximize the use of their benefits Encouraging the use of generics and more affordable brand medications Supporting healthcare providers through evidence-based care support and improving patient adherence to their treatment plans Assisting physicians in managing increasingly complex medication regimens and patient populations Partnering with specialty pharmacies to support patient safety, reduce errors, and improve the lives of patients PBMs want the same thing their clients and consumers want: lower drug prices. Which is why PBMs promote generics over brands whenever possible. The large, sophisticated purchasers who hire PBMs—Fortune 500 companies, major labor unions, and plans in government programs like Medicare Part D—offer performance incentives to reduce overall pharmacy costs. Those incentives are outweighed by rebate on drugs, almost all of which are passed back to payers. The bottom line is that the best antidote to higher prices is more competition. The FDA could facilitate this by approving generics, brands, and bio-similar competi- tors faster so they could get to market quickly. As policymakers explore new ways to make prescription drugs more affordable, they should build on the proven success of PBMs and explore new policies to increase the single, most powerful force for reducing drug costs: More Competition. Focusing on clinical outcomes, their corresponding economic savings, and value-based pricing Offering low cost pharmacy plans that offer convenient access (such as home delivery) and extra discounts at certain pharmacies Negotiating rebates and discounts from drug manufac- turers and drugstores and fostering competition Managing specialty medications billed under both the pharmacy and medical benefits 1 Copyright © 2018 Nalashaa Pharmacy Benefit Managers: Part of the solution to high drug prices
  3. 3. If you would like to bounce off your thoughts on this, let’s have a conversation. Connect with the experts! About Us At Nalashaa, we partner with healthcare organizations, from startups to established firms, and work with them to build solutions with engaging user experiences that reduce organizational cost and risk. Our healthcare and technology expertise, along with our flexible engagement models, make us a great fit for developing the quality technology solutions while reducing time to market and costs. 555 US Highway 1 South, Suite 170, Iselin, NJ 08830, USA 732-602-2560 X 200 Reach Us: Conclusion With a lot of broken pieces to be fixed, PBMs are surely the ones that need to streamline things and make sure drug prices are lowered while the quality is maintained. Fostering competition might be one of the routes to make sure manufacturers are not over pricing. Until that happens at national scale, Surescripts’ real time data integration is something to look at. Having EHRs and Patient Portals integrate with the tool pulling informa- tion around the bio-similars, generics and the pricing of these, will complement the doctors in prescribing better/economic medications and also help the patients choose the one with the lowest prices. As the system strives to deliver on the “Triple Aim” — lower cost, better health, and improved patient experiences — building applications to educate patients about drugs and coordi- nating their care, assisting providers/patients choose the best drug are some of the ways to save the lost dollars in drugs and help patients administer their medications in a more efficient way. We would love to share our inputs and understand your thoughts around this and possibly come to a meaningful solution to this challenge that is the primary focus of the CMS today!