How PBMs are Transforming The Way Pharmacies Operate?

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How PBMs are Transforming The Way Pharmacies
Operate?

• PBMs occupy a complex role in the pharmaceutical
  industry, wielding significant influence over
  drug pricing, formulary management, and pharmacy
  benefit programs. While they have contributed to
  lowering drug costs for insurance companies,
  their opaque practices, potential for conflicts
  of interest, and detrimental impact on pharmacies
  have raised serious concerns.
• It is crucial to address these issues to ensure
  that PBMs operate in a transparent,
  patient-centric, and pharmacy-friendly manner.

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PBMs ARE
H E A L T H C A B E
TRANSFORMING
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JASPER
COLIN
The US healthcare system is a complex and
intricate networI of providers, insurers, and
intermediaries. One of these intermediaries
is Pharmacy Benefit Managers PBMs). Since the
mid-19B0z, PBNs have emerged as a powerful/orcein
the pharmaceutical industry, playing a
significant role in managing the rising costs of
prescription drugs by negotiating discounts
with pharmacies and pharmaceutical
mariu/acturers PBMs manage pharmacy benefits for
over

While PBMs have been touted for their ability to
negotiate lower drug prices,
j
they have also been criticized for their
opaque practices, lacl of transparency, and
potential for conflicts of interest.
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JASPER
COLIN
control over
The top five
morket.
ÅÕ/e Of tG
PBMs employ a variety of practices to manage drug
costs, including Negotiating rebates and
discounts with pharmaceutical manufacturers,
often in exchange for placing their drugs on
preferred formularies.
Formulary management PBMs develop and manage
formularies, which are lists of preferred
medications that insurers will cover.
"
Uti ization management PBMs implement utifization
management techniques, such as prior
authorization and step therapy, to control the
use of certain medications.
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While these practices have been credited with
lowering drug costs for insurers, they have also
been criticized for
JASPER COLIN
Lacks of transparency related to rebate and
pricing methodologies.
Conflicts of interest Rebates from pharmaceutical
manufacturers for placing their drugs on
preferred formularies create a potential conflict
of interest.


Limited patient choice Formulary restrictions can
limit patientsl access to preferred medications,
potentially leading to adverse health outcomes.
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JASPER
COLIN
The rise of P8ts has had a sigrii carit impact
ori pharmacies. PBMs are expanding their reach by
acquiririg pharmacies and otfer healthcare
providers.
PBMs negotiated over 1 triltion
in discounts from pharmaceutical manufacturers in
2019.
goods and services.
Pharmacy profit margins have declined by over
. . .
since 2000.
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PBMs and Pharmacies
need to work together for better patient
outcomes As the PBM landscape evolves, it is
essential to understand their impact on patients,
providers, and the overall healthcare
system. Estimate the impact of prior
authorization on patient outcomes and pharmacy
costs. Leverage research to show how prior
authorization can be effective in controlling
costs and improving patient outcomes. Evaluate
the effectiveness of generic drug
substitutions. Leverage research to validate how
generic drug substitution can lower drug costs
without compromising patient care. Assess the
impact of Medication Therapy Management (MTM) on
patient satisfaction and pharmacy costs. MTM as a
service can help patients manage their
medications, which includes medication reviews,
counseling, and education. There are enough facts
to support the effectiveness of MTM in improving
patient outcomes. By working together,
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TODAY
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