Pharmacy Benefit Management Institute Conference Highlights

The National Business Coalition on Health: Independently Assessing PBM Value for Employers

According to John Miller, executive director, MidAtlantic Business Group on Health, the National Business Coalition on Health (NBCH) is an organization that seeks to drive conversations about prescription drug benefit management (PBM) value. Utilizing an evidence-based comprehensive assessment called ValuePort, NBCH helps employers consider the value PBMs provide in quality (rather than cost alone).

The members and coalitions in NBCH aim to develop programs that underline their 4 pillars of value-based purchasing: “standardizing performance measurement, reporting performance measurement results publicly, reforming the health care delivery payment system, and engaging consumers in informed decision making.” Read more here.

Opportunities in Utilization Management: Making Specialty Drugs Affordable

When it comes to managing chronic conditions and rare disease, the cost of treatment can be astronomical. Fran Gregory, PharmD, MBA, director of specialty pharmacy, Humana Pharmacy Solutions, offered her solutions to PBMI attendees, saying there are a variety of options to manage the rising costs of specialty drugs. Dr Gregory suggested that savings opportunities for providers, payers, and patients must include considerations such as utilization management, cost-effective delivery channels, and increasing adherence among members.

Dr Gregory says that utilization and inflation are related. Because there is a small population afflicted with chronic illness and rare disease, the cost to produce these prescription drugs is spread out among a smaller amount of patients. As inflation increases, so does the cost. For instance, one multiple sclerosis drug cost about $1500 in 2007. Today that same drug costs $4600. Read more here.

The PBM Has No Clothes: A (Public Sector) Proposal Is More Transparent Than You Think

In a presentation entitled “The PBM Has No Clothes: A (Public Sector) Proposal Is More Transparent Than You Think,” Steffanie Mathewson, Esq, principal, Mathewson Research, described how the Freedom of Information Act (FOIA) and state sunshine laws make it easier for stakeholders to view and understand the “strategic direction” of major PBMs. Her findings also report that 60% of RFP requests are for commercial purposes.

The FOIA (Title 5 of the United States Code, Section 552) provides any person the right to request and receive access to non-confidential records/documents maintained by federal agencies or local governments. It also includes groups such as Medicare contractors and, growingly, PBMs. Similarly, the Sunshine Act promotes transparency and access by requiring manufacturers of drugs, medical devices, and biologicals that participate in US federal healthcare programs like Medicare or Medicaid to report certain payments and items of value given to physicians and/or other entities such as teaching hospitals. Read more here.