2025 GSHHRA Annual Conference-Greg Redlinger - PBMs and Rx Landscape

Greg Redlinger - PBMs and Rx Landscape - Where do we go from here

Pdf Summary

The document from Arthur J. Gallagher & Co. outlines key issues, trends, and strategic recommendations in the pharmacy benefits landscape for 2024 and beyond. It emphasizes the need for transparency and clarity in the pharmacy benefits management (PBM) industry to align with original industry intentions that prioritize patient care over profit. The document highlights ongoing challenges such as complex drug pricing systems, widespread use of biosimilars, and ongoing pricing games played by PBMs. Moreover, it notes the emerging requirement for transparency beyond simple pass-through models to ensure best rates rather than just pre-determined rates.<br /><br />Notably, there is a focus on various strategic initiatives and pricing models like CVS's TrueCost model, ESI ClearCareRx options, and Cost Plus models. Concerns include the consistency of markups across pharmacies and how acquisition costs are computed.<br /><br />The document also discusses the rising importance of generic and biosimilar medications, forecasting large savings and a broader range of cost-saving opportunities due to increased generic launches. This includes potential price reductions for medications related to heart conditions and chronic diseases.<br /><br />Emerging trends, such as the increasing role of weight loss drugs like GLP-1 receptor agonists and the evolving landscape of heart failure treatments, reflect advancements in treatment strategies with significant potential impacts on both cost and patient care.<br /><br />Strategic considerations outlined include custom formulary strategies, compliance reviews, incorporation of innovative funding strategies, and rigorous contract reviews to ensure optimal economic and clinical performance. It underscores the need for regular audits and evaluations to address evolving market dynamics, regulatory changes, and to harness new opportunities for cost management in pharmacy benefits.

Keywords

pharmacy benefits

transparency

PBM industry

drug pricing

biosimilars

generic medications

strategic initiatives

pricing models

cost management

treatment strategies