Pharmacy Benefit Management Helping to Innovate Health Care

Pharmacy benefit managers (PBMs) may not be the most visible players in health care today, but these organizations have an important position in helping control drug costs in the United States and they continue to take on new roles.

The traditional function of PBMs – which date back to the 1970s -- is to “process prescriptions for the groups that pay for drugs, usually insurance companies or corporations, and use their scale to negotiate with drug manufacturers and pharmacies,” as Forbes noted.

The PBM market is now worth roughly $263 billion, according to Forbes. “Like any part of the health care industry that survives, PBMs have shapeshifting powers, changing and evolving with the times,” a recent Managed Care article proclaimed. “PBMs can, with some justification, brag that they are one of the few bona fide success stories in the management of health care costs.”

In 2015, these companies are helping reduce costs by tackling drug nonadherence, which is a major source of health care waste. They’re also striving to take advantage of the potential efficiencies of e-prescribing.

Mobile apps may help improve patients’ adherence

Nonadherence, which means taking prescribed medications incorrectly or not at all, costs the US health care system up to $289 billion each year. The reasons why people miss doses or quit taking their medications are legion (forgetfulness and lack of perceived benefit of the medication are just a few).

Some PBMs are exploring the advantages of using mobile apps to improve patients’ adherence. In March, MedImpact Healthcare Systems announced that it was offering an app developed by Mango Health that gives patients information about the medications they’re taking, based on MedImpact claims data.

The app can remind users when it’s time to take a dose or refill their prescription. And, according to Specialty Pharmacy Continuum, by offering users a chance to win points – as if they were playing a video game – the app may help motivate them to use their medications properly.  

This isn’t the only way that PBMs are using innovative techniques to bolster adherence. Later in August, this blog will look at how some of these companies are working to predict which patients will be at higher risk of poor adherence.

Prescriptions move into the electronic age

Upward of 91 percent of community pharmacies and 34 percent of office-based providers were able to rout prescriptions electronically in 2013, according to US Pharmacist.  

Advantages of e-prescribing include “enhanced patient safety and decreased medication errors, reduced drug costs with FDS [formulary decision support] software, increased access to patient medication records, and improved pharmacy workflow,” the journal notes. However, some concerns remain, such as the potential to introduce prescription errors.

E-prescribing may also present another tool for improving medication adherence. Surescripts, which offers e-prescribing services to PBMs, found in a study that physician e-prescribing was linked to a 10-percent higher chance that patients would pick up a new prescription.

Independent review organizations can help PBMs

Every day, PBMs make decisions that help influence the cost and quality of health care for millions of Americans. Independent review organizations (IROs) are well-positioned to provide valuable medical expertise to pharmacy benefit managers.