How will PBMs be affected by current trends?

You can certainly see the piece of the PBM world that I’m wrapped up in right now, but these seem to be important trends.

What are the most likely developments/trends that could affect pharmacy benefit executives in the year ahead? Why?

While healthcare reform or market consolidation could impact the industry, we don’t see either as having a material impact in 2010.  We expect several trends.  There will continue to be a focus on mail order utilization, specialty pharmacy market share, and generic fill rate, and the sophistication of those programs will continue to evolve.  PBMs will look at how to predict responses by patients to offers such as retail-to-mail and subsequently segment the market using variables such as condition, age, and plan design.  PBMs will continue to develop strategies to address programs like $4 generics, 90-day retail, and pharmacy to employer direct contracting.  We have also seen a huge focus on adherence which will take several forms – automated refill programs, physician focused programs, and pharma-funded programs.  Additionally, there will continue to be efforts to create a single view of the member in a longitudinal view of their claims and intervention history.  PBMs will begin to think and act more like consumer companies employing techniques like motivational interviewing and behavioral economics.

How might pharmacy benefit executives most effectively prepare for these important trends?

Executives should be developing processes with an inside-out perspective that focuses on how the consumer experiences the PBM not how the PBM optimizes their process.  They should be looking at how they blend claims data, lab data, communications data, and event data (e.g., website visits) to have a holistic view of the patient.  Additionally, PBMs need to have a rapid testing strategy for how they evaluate consumer hypotheses and rapidly improve programs while capturing insights about their population.