Unbiased Analysis of Today's Healthcare Issues
A helpful article from Mattingly et al. (2023) describes history, business practices, economics, and policy for pharmacy benefit managers (PBMs). Part of this article explains how PBMs make money. They claim there are three primary avenues. Rebate retention. Plan sponsors pays the list price of the drug net of rebates and discounts received. PBMs are…
How do pharmacy benefit managers (PBM) claim they can reduce cost? A Health Affairs Forefront article by Brennan and Shrank (2023) identify 6 key pathways: Mail order. Mail order alternative is often cheaper than dispensing at the retail pharmaciesdue to greater scale and automation Negotiating power. PBMs leverage purchasing power to lower dispensing fees. PBMs…
A ViewPoint by Richman and Adashi in JAMA this week provides a nice overview of the pharmacy benefit manager (PBM) marketplaces as well as some considerations for the Federal Trade Commission (FTC) to consider. Below I summarize some of the developments in the PBM market in recent decades. Of particular note is that PBMs have…
According to this study, I would certainly say yes! “The study reviewed pharmacy claims from the CVS Caremark pharmacy benefit management (PBM) book of business for 1.83 million patients taking statins, and 1.48 million patients taking angiotensen converting enzyme inhibitors (ACE inhibitors) or rennin angiotensen receptor blockers (ARBs) between June 1, 2006 and May 30, 2007… During a three-month…
CVS is the second largest pharmacy in the U.S. with over 7000 stores. Caremark Pharmacy Services is a pharmacy benefit management (PBM) company, providing benefit management services to health plans. In March of 2007 the two firms merged. The combined firm not only has $99 billion in sales, CVS Caremark also has the ability not to…