The continuing consolidation of the PBM business has led to two things:

  • PBM purchasing power has grown dramatically
  • Managed markets teams are having harder time assessing business performance

Each PBM is a heterogeneous mix of business segments each characterized by variances in:

  • Funding sources
  • Membership base
  • P&T objectives
  • Benefit design
  • Patient demographics

Therefore understanding PBM performance at the individual plan, MCO, employer group level is more important than measuring account performance at the ESI or CVS level. The typical managed markets team lacks the visibility into the varying business dynamics in play within a large PBM.

Complete the quick survey below to evaluate your organization’s readiness:

1. Using contract data, can your current analysis tools calculate NRx, Persistency, Patient Compliance, and Rx Reversals at an individual PBM-member or employer group level?

  • Yes
  • No

2. Do you get timely reports that track which employer groups are not complying with contract terms and which groups are new adopters of your contract?

  • Yes
  • No

3. Can your systems analyze PBM customers in an automated fashion without the need for cumbersome spreadsheets and manual processes?

  • Yes
  • No

If you answered No to any of the questions above, it is time to develop a more systematic way to capture, review, and account for the underlying dynamics driving PBM performance.

Once you are able to understand your PBM business in more granular detail, your account teams will dramatically benefit from improved customer knowledge, your decision-makers will have greater confidence in the data, and your strategies will be founded on a more nuanced understanding of the market.