My Eight PBM Predictions For 2012

I recently heard one of the key CEOs in the PBM industry say that his crystal ball for 2012 was fuzzy, and he wasn’t sure what was going to happen.  (Not particularly reassuring.)  That being said…it’s an exciting time, and I’m going to take my pass at predictions anyways.

1. The proposed Express Scripts acquisition of Medco will take place although they will be required to sell off some specialty assets.  This will create a new specialty player and will also trigger further consolidation and acquisitions.  You will also see many of the Medco people go to new healthcare companies throughout the industry to drive change.
2. The contract dispute between Express Scripts and Walgreens will get resolved shortly after 1/1/12, but it will serve as the trigger for limited networks as multiple clients will keep Walgreens out of the network since they’ve addressed most of the disruption and achieved savings.  But, you will also see several companies quickly add Walgreens back into their network.
3. Star Ratings will trigger a bigger focus on adherence across the industry and begin to create outcomes-based performance measures that the commercial business starts to see in their PBM contracts linking payment to performance.
4. Lipitor will be a disruptive item throughout the year with aggressive Pfizer rebating, the overhang from it potentially going OTC, and the pricing of the initial generic.
5. Innovation will finally begin to shift to the specialty space with this being the primary area of concern from a trend management and clinical perspective.  Clients will expect innovative ways of engaging patients and improving outcomes which will push closer links between pharma and PBMs around key drugs and complex conditions.  The focus on specialty spend in medical will continue, but the increasing percentage of infusion drugs will challenge this and push specialty to look for more ways of engaging with the physician.
6. The “retailing of healthcare” through storefronts will manifest itself in different ways in pharmacy with greater focus on specialty at retail, pharmacists as part of the ACO/PCMH concept, MTM, and ultimately through exchange based partnerships with large payers.
7. Integration of medical, pharmacy, and lab data will be a huge focus on PBMs create targeting algorithms and databases for segmentation, targeting, and ultimately engaging consumers around specific health behaviors.
8. Telemedicine in the form of telemonitoring will link into the retail pharmacy clinic strategy as they extend their pharmacy relationship from an event based relationship to an ongoing monitoring relationship around key conditions like diabetes.

Two things that I expect to continue to be areas of focus will be the development and execution of a mobile strategy and continued exploration in the area of personalized medicine and genomics.

The one outlier which I’m not sure of yet is Medicaid pharmacy.  It’s been a hot topic lately, but I’m still unsure of whether that will radically change in 2012 or not.

[Interested in sharing your opinions on 2012 in a formal way?  I’m going to reach out to several companies and ask their thought leaders or executives to do an “interview” with me about their predictions for 2012.  Let me know if you’d like to participate.]

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