How Pharmacy is at the Forefront of an Evolving Prescription Benefits Landscape

Through the interplay of discounts and rebates provided to a variety of stakeholders in the drug supply chain, the distribution of pharmacy benefits in the US is complex. Amid narratives that pharmacy benefit provisions are focused on cost rather than value, experts believe that the role of pharmacy benefit managers (PBMs) and pharmacists in dispensing medications is truly at an unprecedented turning point.

“[The Big 3 PBMs’ control] was really driven by that issue around scale and around the inappropriate way, in my view, that pharmacy benefits are sourced,” Bill Wolfe, COO at WriteWise and former President of Aetna’s Pharmacy Management team, told Drug Topics. “Just looking at your discounts and your rebates kind of feeds into the narrative that pharmacy benefit provision is just about cost. Well, it's not.”

Indeed, according to Wolfe, prescription drug benefits are some of the most important for patients and payers alike, accounting for up to 25% of all medical benefits. And with the significant patient-facing and accessible roles that pharmacists play in the health care community, they are at the forefront of an evolving pharmacy benefits industry.

In part 1 of our interview with Wolfe, he explored the evolution of the Big 3 PBMs—CVS Caremark, Optum Rx, and Express Scripts—and how their acquisitions and growth have all amalgamated to a notable time in pharmacy today. First, he explored the evolution of PBM control over the pharmacy benefits market. Wolfe then dove into the significant role pharmacists play in this space as well as the tools and technology they’ve used to facilitate their roles as medication experts and administrators.

“Why the PBMs have come under such scrutiny is that folks go through this exercise every year or every few years. They think, ‘Okay, I got a new deal, I'm going to save money,’ and then they don't,” added Wolfe. “Even though the PBMs hit their guarantees at the discount and rebate levels, the client still spends. The cost just keeps going up, while the consumer also continues to pay more out of pocket. We're really at a crossroads.”

READ MORE: NCPA: More Than 125 Groups Urge Congress to Pass PBM Reform

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