PBM Data – Apples and Oranges

2 Responses to “PBM Data – Apples and Oranges”

1. 

   Susan Namovicz-Peat Reply August 19, 2010 at 10:15 am

   Thanks for your citation to the AIS’s Quarterly Pharmacy Benefit survey, chart originally published in 8/13/10 issue of Drug Benefit News. As the director of this survey, I want to add my insight on some of your points.

   I would like to clarify that Express Scripts, Medco, and CVS/Caremark do participate in the survey, although obviously not with regard to the “% of claims per tier” set of questions addressed in this particular chart. I believe benefit design issues such as tier definitions and copay levels are typically decided at the plan/client level, so a PBM with a very diverse client base may not have the information to track this across their book of business and may not feel that such a compilation would be valid. I invite all participants to answer only the questions that apply to their particular business model, and as you pointed out, there are many.

   The fine print that DBN published at the bottom of our original chart addressed some of the points you raised about whether the companies defined tiers in the same way (no), or whether they have similar business models (no) or whether they served similar populations (no). The intention of the survey is to compare pharmacy benefit metrics to the extent possible, while still keeping the survey open to all companies that offer competing or alternative approaches to those offered by the “big 3” PBMs. PBMs are incredibly disparate—apples and oranges as you observed, plus many stranger fruits! I like to think that by acknowledging and embracing this fact my survey provides an important tool for transcending the Medco/Caremark/Express Scripts narrative and furthering evolution in the field.

   Of course this often makes it very challenging to draw conclusions from the survey results, and I applaud your attempt to apply the data to your specific questions. For the most part, I think the conclusions you were able to draw from the data made a lot of sense. While my role is to simply research and share the raw data with all its caveats, you’ve provided a really nice example of how I hope end-users will take bits and pieces of the data and combine with other knowledge to further their own understanding of the pharmacy benefit.

   Susan Namovicz-Peat
   Director, Directories & Databases
   Atlantic Information Services, Inc.
   snpeat@aispub.com

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     George Van Antwerp August 19, 2010 at 2:30 pm

     Susan –

     Thanks for the detailed comment. Just to be clear…I love the research that you do and find it very helpful. I do think any data used without a deep understanding can be mis-used. PBM data is often very difficult to compare (often intentionally). I often find it funny that some people at the Big 3 don’t even know about the smaller PBMs. I brought up Catalyst to a sales person at one company the other day and they didn’t even know who they were. I was surprised, but I know life can be fairly myopic if you let it be.

     I would argue that the larger PBMs do have the data across tiers so I’m not sure why they wouldn’t share it. It’s always a proxy and does vary dramatically based on client plan design.