Pharmacy benefits managers, or PBMs, run prescription drug plans for employers, insurers and other customers.
PBMs advise employers and health maintenance organizations how to save money on prescription drug costs.
PBMs are likely to come under increasing pressure and disintermediation in the private sector.
FORBES: Super Committee Sets Up A Great Opportunity To Short Health Care
Pharmacy Benefit Managers (PBMs) have been touted by Wall Street as part of the solution.
FORBES: Super Committee Sets Up A Great Opportunity To Short Health Care
If PBMs do cause drug prices to go down, consolidation may not be the culprit.
The law also compels the Federal Trade Commission to investigate PBMs for potential abuses of their market power.
Walgreen initially played along, partly because of its symbiosis with PBMs that okay one-time orders for drugstore pickup.
More than half of mail order is controlled by three PBMs: Express Scripts, Medco Health Solutions and Caremark.
PBMs are under legal assault from unions, states and retailers, with allegations ranging from overcharging to antitrust violations.
These programs could conceivably allow PBMs to tell large employers that they are both helping patients and saving money.
Toan believes PBMs like Express Scripts provide a much-needed check on drug prices.
Walgreen can't strong-arm the big PBMs. So it's trying to reach them obliquely.
In the United States, PBMs are the largest processors of prescription drug claims.
FORBES: Super Committee Sets Up A Great Opportunity To Short Health Care
That's because PBMs steer consumers away from generics and toward more expensive brand-name drugs, for which they're rewarded by manufacturers.
PBMs argue that when the dust settles, drugs will end up costing more--and make health insurance all the more expensive.
While there are 100 PBMs, the industry is highly concentrated with the top four PBMs controlling 65% of the revenues.
FORBES: How Catamaran is Revolutionizing Pharmacy Benefit Management
Like other PBMs, the combined company will negotiate with drugmakers to get lower prices for prescription drugs for health insurers and employers.
While Express Scripts might be hired to reduce costs, it and other PBMs provide another benefit to consumers: They help catch doctors' mistakes.
While grabbing the 90-day refills by persuading health insurers to offer patients bargains on the copays, the mail-order PBMs steer one-shot orders to stores.
If a Medicare prescription drug benefit is passed and the government buys drugs through PBMs, the price of widely used pills could decrease, Sylvester says.
Toan sees the PBMs as a bulwark against ever-rising drug costs.
PBMs and drugstore chains that are the large drug firms' customers.
Few object to the behavioral economics techniques practiced by pharmacy benefit managers (PBMs), since the intended outcome increased drug compliance benefits the patient.
FORBES: NYC's Soda Ban Is A Good Idea, But A Tax Would Be Better
This vast and complex plan will be run by private middlemen--chiefly HMOs and PBMs, with assists from pharmaceutical companies--some of whom have been offenders in the past.
Catamaran was originally focused solely on providing software for PBMs that mediate between drug makers and retailers on behalf of employers and other health care plan providers.
FORBES: How Catamaran is Revolutionizing Pharmacy Benefit Management
Sylvester, a pharmaceuticals analyst at UBS. But PBMs can have a positive impact for drug companies as well, he says, by encouraging patients to stay on their drugs.
One big reason for this is that the biggest PBMs have the best negotiating leverage with drug companies and retailers so they are best positioned to offer customers the best prices.
FORBES: How Catamaran is Revolutionizing Pharmacy Benefit Management
On any bounce, stocks of PBMs are a short.
FORBES: Super Committee Sets Up A Great Opportunity To Short Health Care
If plan sponsors demand the same transparency and accountability from PBMs that they routinely demand from other strategic suppliers, they will see many opportunities to get more bang from their health care buck.
PBMs are third-party administrators of prescription drug programs.
FORBES: Super Committee Sets Up A Great Opportunity To Short Health Care
应用推荐