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In Land of Giants, Smaller PBMs Find a Niche

  • 10/15/2020
  • Managed Healthcare Executive

In the consolidated PBM industry, smaller companies say they can be nimble and not driven by rebates. But are they acquisition targets?

The pharmacy benefit management (PBM) industry used to occupy a rather small, obscure corner in the back offices of the American healthcare system. PBMs were just prescription claims processors. But over the past 20 years or so, the industry consolidated and the remaining companies became powerful middlemen in the complex pharmaceutical supply chain. Now the industry has an increasingly high profile (not always for favorable reasons) and has consolidated even further, with its large players owned by or partnering with even larger companies.

Yet plenty of smaller players have survived and even thrived by finding a niche, such as workers’ compensation, specialty drugs or certain types of diseases. They offer an alternative to dominant companies and the traditional marketplace, which can be layered and complicated.

3 strategies to promote the value of medication adherence among plan members

  • 10/1/2020
  • BenefitsPRO

As the pandemic exacerbates barriers to adherence, promoting the value of taking medications as prescribed is more critical than ever to improve member health and cost savings.

Even before the COVID-19 pandemic rattled the country, medication non-adherence—when patients fail to take their prescriptions as prescribed by a doctor or pharmacist—has been an ongoing issue causing serious health consequences and unnecessary medical costs. In fact, non-adherence to medication leads to a financial burden of $100 billion to $290 billion on the U.S. health care system annually, which causes significant ramifications for plan sponsors who consequently experience higher medical costs and lost earnings and productivity.

A Look at the Year in Generics

  • 9/9/2020
  • Drug Topics

The generic pipeline continues to provide significant value to payers and patients as key products in top therapeutic classes lose patent protection.

Ryan Schmidt, associate director of formulary services for Madison, Wisconsin–based Navitus Health Solutions, says that overall, the generic market this past year has been relatively slow.

“There haven’t been many blockbuster generic releases, and the ones that hit the news are generally ‘authorized generics,’ where the manufacturer of the generic product either has an agreement with the brand manufacturer, or in some instances is the brand manufacturer,” he said. “The other thing that limits impact of these releases is a lot of them have come from classes with multiple alternative generic options already, meaning the amount of use in the brand space has been limited.”

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