Providers, pharma and PBMs: Three things to watch
Providers and pharma and pharmacy benefit managers (PBMs) – I refer to them as the “three Ps” and they make up what I suppose you could call the Trinity of pharmaceutical benefit delivery in this country, and have been much in the news as of late. And it’s not a stretch to say that the news hasn’t exactly been positive. Here are three things I think all of us need to keep tabs on.
Of course the news of the day is the suit filed by a major carrier – Anthem – against a major PBM – Express Scripts.
Anthem is claiming that Express Scripts is not performing up to the intent of their contract, and that they’re not delivering on promised pricing (which also includes pharmaceutical manufacturer rebates).
It’s going to be very interesting to see where this goes.
Express Scripts actually bought a PBM called NextRx from Anthem a few years ago and was performing under a promise of that purchase, and I believe there are still many years remaining on their contract.
This occurrence bears watching because this could set a precedent for how everyone views their PBM contracts, and how they’re going to really scrutinize performance moving forward.