Flaspohler PBM Survey

I was not familiar with this survey and stumbled across it the other day – 2008 Flaspohler PBM Survey. For those of you that follow the space, it has some interesting data in it. Here were a few of my notes:

• It was a survey of 259 executives from MCOs (health plans), self-insured employers (SIs), third party administrators, and consultants.
• This is the 2008 survey, but it has been conducted annually since 2000.
• 70% of MCOs and 90% of SIs were either somewhat or very satisfied with their PBM.
• 86% of the MCOs had been with their PBM for more than 2 years.
• 75% of the MCOs cover OTC (over-the-counter) drugs compared to only 25% of SIs.
• Both MCOs and SIs reported “relationship oriented” being the most important factor in selecting a PBM. (Really? It seems like price is always how the decision gets made.)
• They rate the highest PBMs by a bunch of factors:
  • Attractive pricing
  • Relationship oriented
  • Effectively uses technology
  • Effective tools to manage drug benefit costs
  • Flexibility
  • Mgmt reporting
  • No “conflict of interest”
  • Unique programs and services
  • Superior specialty pharmacy
• They gave the top 5 in each of those categories. What stuck out to me is that Express Scripts only appeared once out of the 18 possible boxes (9 categories ranked by both MCOs and SIs). That surprises me given my familiarity with them.
  • Later, in the rankings by consultants, they did appear more which says they are doing a better job there of getting the word out and education.
  • Several other companies appeared only once which was surprising (Aetna and UHC), but they were unlikely to be ranked by other MCOs.
• It also surprised me that Medco only appeared 3 times and Cigna 4 times.
• The other companies that appeared were Argus, Catalyst, MedImpact, SXC, Wellpoint Next Rx, Prime Therapeutics, CVS Caremark, Humana, NMHC (now SXC), UnitedHealthcare, Walgreens, Partners Rx, and Prescription Solutions.
• Only 10% of SIs but 27% of MCOs have an exclusive specialty pharmacy provider.
• They then looked at the specialty pharmacies across 5 categories:
  • Use and have an exclusive relationship with
  • Would consider using
  • Know little or nothing about
  • Use but not exclusively
  • Know but would not consider using
• The three categories that interested me were exclusive relationships, ones that the MCOs know little or nothing about and those they would not consider using.
  • Exclusive relationships were with CVS Caremark, BioScrip, and Express Scripts (CuraScript) primarily.
  • Of the biggest names, it was surprising that people knew little about PrecisionRx (Wellpoint) and Wal-Mart.
  • Of those they would not consider using, two were in excess of 30% – Walgreens and Accredo (Medco).