THE BUSINESS OF PHARMACY PODCAST recently explored the complex relationship between PBMs, Pharmacies, and Plan Sponsors.
Host Mike Koelzer spoke with former HealthTrust SVP of IHP, Joey Dizenhouse, about the intricate relationships between pharmacy benefit managers (PBMs), pharmacies, and plan sponsors in the pharmaceutical industry.
Dizenhouse explained the role of PBMs as intermediaries between drug manufacturers and health plans, negotiating drug prices and benefits for plan members. He also discussed the challenges faced by independent pharmacies in competing with larger chains and negotiating fair reimbursement rates with PBMs.
Additionally, Dizenhouse highlighted the importance of plan sponsors understanding the complexities of the pharmaceutical supply chain and partnering with the right vendors to achieve cost savings and improved health outcomes for their members.
Highlights from the conversation:
- Negotiation requires leverage, subject matter expertise, and HealthTrust’s tenacity in negotiating master agreements between PBMs and the entity with their insurance plan, ensuring the incentives of the PBM align with the best interests of the plan and its members
- Negative impact of choosing brand name drugs over cheaper generics on pharmacies Importance of preserving competition in the industry to ensure consumers receive the best value
- Delays in launching generics and biosimilars can impact plan sponsors
- Rising cost of pharmacy expenses and the need to stay ahead of the curve to protect against future increases
- Factors that contribute to the rising cost trend in pharmacy, and how good contracts with PBMs can provide flexibility while educating prescribers and patients about the cheapest available drugs Importance of a medical exception process to ensure access to expensive medications
- Communication between PBMs, patients, and healthcare providers is crucial
- Role of pharmacists, brokers, and consultants in navigating the complex world of PBMs.
Discover the new standard in pharmacy benefits management with HealthTrust IHP and download the infographic – Top 5 Things You Must Know to Negotiate a PBM Contract here
