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PBM Swan Song Time?


Let’s see if we can get your attention……

“The market structure we have right now—three big PBMs dominating the market—will probably not be the one we will be with over the long run.”

That statement is central to the article we suggest today for your reading pleasure. It strongly suggests that the way PBMs operate, and the service offerings they are already offering in response to market pressures, are shifting the ground under which healthcare is delivered. We suggest that providers in the delivery channel also need to understand these changes to survive and thrive.

The article starts out by detailing how Blue Shield of California chopped its well established PBM in favor of a tutti frutti solution that includes —–

  • Amazon Pharmacy – fulfillment
  • Mark Cuban Cost Plus Drug Company – simple, transparent, pricing 
  • Abarca – claims technology
  • Prime Therapeutics – negotiate savings with drug manufacturers toward value-based models 
  • CVS Caremark – will continue supporting specialty pharmacy services

The article is thought provoking as it is a peek behind the curtain of what appears to be the next generation of PBM hegemony. Most staff are only generally familiar with the ‘OG’ PBM model so this article should be considered required reading. 


PBMs Are Evolving. Here’s What HR Needs to Know

When nonprofit health insurer Blue Shield of California announced in August that it was making a significant shift in how it administers pharmacy benefits for its 4.8 million members, the health insurance industry took notice, and so did the financial markets: CVS Health, the parent company of the insurer’s outgoing pharmacy benefits manager (PBM), saw its stock plummet 8 percent the day Blue Shield made its decision public.

The Oakland-based insurer’s new model, called Pharmacy Care Reimagined, includes new relationships with four entities in addition to the CVS PBM, known as CVS Caremark. In announcing the new model, Blue Shield said……………………………

CICK HERE to read the full article


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