January 1, 2012 
One thing that I often think about is the amount of change in the teams within rapidly growing companies (e.g., many PBMs). Does this have an effect on internal knowledge, productivity, and therefore success? It’s a great question. With that in mind, I found the infographic below very interesting.
At the same time, I looked back a few years to see how much change there has been in the management teams at each of the largest PBMs (Medco, Express Scripts, and CVS Caremark). [Honestly, it was less change than I had expected, and I didn’t look at average age since I’m not sure that’s a great proxy in business while it may be in sports.]
- At Express Scripts, 7 of the 10 people listed on the website have been there that entire time. Most of them in their current roles.
- At CVS Caremark, 6 of the 10 people listed on the website have been there that entire time althought there has been more movement across roles.
- At Medco, 14 of the 16 people listed on the website have been with Medco that entire time and the two others might have also but their start date wasn’t listed in their bio.
So maybe more change is needed? Certainly with the changes in the market dynamics, there is always a need for bringing in a fresh perspective…at the same time, the PBM industry is complex and continuity given long-term contracts is important.
Enabling Healthy Decisions 
^That is true. The industry has matured, and most of the large gains have been realized within the given business model. So we’re now having to go after smaller and smaller gains, which results in increased product complexity. Just look at how many 3D programs Autodesk sells.
http://usa.autodesk.com/adsk/servlet/item?id=8909451&siteID=123112
All this also makes us highly susceptible to exogenous events, because there is so little wiggle room to maneuver around and grow top line.
It’s an interesting time to be part of PBM to say the least.
The PBM industry is complex but the PBM business is a simple process; PBM complexity is self produced and intentional, made complex for the soul purpose of profits. This self produce PBM complexity is the biggest and basically the only problem with prescription cost. Our business’s hardest job is most often the explaining to clients of how simple the process is.
Jim Fields CFO ApproRx