MMIT brings transparency and guidance to pharmacy and medical benefit information

Though PBMs are most known for the influence they have on prescription drug costs, some firms are increasingly focused on offering high-touch condition management services that give them a more active role in patient care, AIS Health reported.

Though PBMs are most known for the influence they have on prescription drug costs, some firms are increasingly focused on offering high-touch condition management services that give them a more active role in patient care, AIS Health reported.

For specialty PBM AscellaHealth, LLC, that means harnessing a variety of resources to help better manage treatment for hemophilia, a notoriously expensive disease state.

Not only does the PBM leverage its specialty pharmacy network to obtain the best prices for hemophilia clotting factor, but it also uses technology to monitor medication dispensing in real time and provides clinical interventions when necessary, explains Mike Baldzicki, AscellaHealth’s executive vice president of growth and strategy.

“Managing cost and quality kind of go hand in hand in this regard,” adds Dea Belazi, the PBM’s CEO.

Meanwhile, CVS Health Corp. is expanding its Transform Diabetes Care program, which helps members of its PBM, Caremark, control their diabetes by providing technology-enabled, personalized support and coaching focused on improving medication adherence and controlling blood-sugar levels. As part of the expansion, the program will also focus on the prevention and early identification of diabetes as well as hypertension, which is twice as common in diabetes patients as the regular population.

While care-management programs are hardly a new concept in the health care industry, “the new part, I would say, is putting the PBM at kind of the center of these programs,” says Ashraf Shehata, a principal in KPMG’s health care life sciences advisory practice and the firm’s Global Healthcare Center of Excellence.

In the PBM space, firms are increasingly integrating traditional medication therapy management with connected medical devices “to help create a much more visible data and information stream around people’s ability to successfully accomplish their medication regimen,” he says.

Large employers are increasingly leaning on their health plan and PBM partners to devise innovative solutions to health care challenges, according to the 2020 Large Employers’ Health Care Strategy and Plan Design Survey conducted by the National Business Group on Health (NBGH), AIS Health reported.

Large employers are increasingly leaning on their health plan and PBM partners to devise innovative solutions to health care challenges, according to the 2020 Large Employers’ Health Care Strategy and Plan Design Survey conducted by the National Business Group on Health (NBGH), AIS Health reported.

In the 2019 survey, 32% of large employers said they would take a “defer to partners approach” to drive health system change — implementing what their health plan and PBM present as the latest developments. For 2020, that share rose to 41%.

NBGH attributes that trend to a number of factors, Ellen Kelsay, NBGH’s chief strategy officer, said at a press briefing. One is that employers are “frustrated with the slow pace of change” in health care and are looking to their partners to speed it up. Most employers also lack the bandwidth to drive change on their own, she said.

What’s more, “many employers are looking for a way to streamline and consolidate their offerings,” Kelsay said, noting that the ecosystem of solutions that employers have at their disposal is “far too extensive.”

Employers are also turning to their health plan and PBM partners to figure out how to finance and manage high-cost therapies, NBGH President and CEO Brian Marcotte said at the briefing. The survey revealed that such high-cost therapies — like Novartis’ $2.1 million spinal muscular atrophy drug, Zolgensma — are employers’ No. 1 concern when it comes to managing their pharmacy benefit plans.

So how can health plans and PBMs meet employers’ desire for more help driving health care change?

They “can be proactive in reaching out to their clients to engage them on emerging trends and opportunities and propose solutions, rather than waiting for their clients to approach them,” Marcotte tells AIS Health via email.