April 20, 2016

Last week PCMA held its annual PBM Policy Forum where industry leaders convened to discuss market-based solutions to lowering the cost of prescription drugs, including the use of biosimilars, specialty pharmacies, and value-based contracting, as well as managing costs in the medical benefit.

Recognizing that high drug prices is one of the thorniest and more prevalent issues in healthcare today, PCMA President and CEO Mark Merritt led the discussion by acknowledging that business practices and policy solutions need to preserve patient access at affordable costs. “The best way to reduce cost in a consumer-friendly way is to use innovative management techniques that increase choice and competition,” Mr. Merritt shared.

“The drug pricing debate involves more than the unit price of drugs. In building on PBMs’ success in managing drug trend in the commercial market, we must create more competition in the market, align incentives for prescribers, patients, and payers alike, and reduce the costs of pharmacy services,” Mr. Merritt concluded.

Everett Neville and sPCMA Board of Director members Chris Bradbury and Alan Lotvin also presented on the value of specialty pharmacies, value-based contracting, and medical benefit drug management tools in managing costs during this high-priced drug era.

View meeting highlights and read the full session summary.

Specialty Pharmacies Are Crucial to Drug Cost Management
Everett Neville, Senior Vice President, Supply Chain – Express Scripts

Mr. Neville estimated about $300 billion a year is wasted by patients not taking their medications correctly or taking the wrong medications, resulting in additional medical costs, increased hospital admissions, side effects, and Emergency Room visits. When specialty pharmacists guide patients through each step of their treatments and apply PBM tools to the process, specialty pharmacies continue to achieve markedly different impacts on clinical outcomes and cost reductions from unmanaged patient care, up to a 50% difference in trend.

View the video highlights.

Managing the Escalating Cost and Utilization of Medical Benefit Drugs
Alan Lotvin, Executive Vice President, CVS/specialty – CVS Health

PBMs encourage the use of prior authorization tools in the medical benefit. Dr. Lotvin explained, “by using relatively non-aggressive prior authorization, it’s possible to take out 3% of the drug spend under the medical benefit. When applied to the Medicare population, this could save $1.3 billion. Without impairing or restricting care, it is possible to make a huge impact on the budget with a relatively small amount of work.”

View the video highlights.

Value-Based Contracting and How It’s Being Applied in the Commercial Marketplace for Savings
Chris Bradbury, Senior Vice President, Integrated Clinical Solutions & Specialty Pharmacy – Cigna Pharmacy Management

As the industry progresses toward an explosion of innovation, patients and all stakeholders must be committed to managing the total affordability and sustainability of healthcare long-term. In the midst of these increasing expenditures, PBMs are asking manufacturers to stand by their products in the real world and rely on the support of specialty pharmacies to provide the right support to patients and providers.

View the video highlights.

Additional Information