Pharmacy benefit management system is operated by third party administrators who act as the link between the manufacturers, pharmacies, insurers, and the customers. Moreover, the system help provide employers with prescription drugs and medical services at reduced costs. The cost reduction is achieved by entering in contracts with pharmacies, through rebates with the drug manufacturers, […]
The Significant Role of Pharmacy Benefit Management in Healthcare
Pharmacy benefit management system is operated by third party administrators who act as the link between the manufacturers, pharmacies, insurers, and the customers. Moreover, the system help provide employers with prescription drugs and medical services at reduced costs. The cost reduction is achieved by entering in contracts with pharmacies, through rebates with the drug manufacturers, paying prescription drug claims, and by working with self-insured companies and government programs. Over the years, the cost of medication has increased more than any other healthcare expenses. Thus, there is a need for pharmacy benefit management, which in turn is expected to fuel the growth of the pharmacy benefit management market.
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Market players are focusing on bringing a simpler business model, new technology, and more transparency. For example, in July 2021, Major insurers Anthem and Humana teamed up with SS&C to launch a next-generation pharmacy benefit management platform, named DomaniRx, to offer its users with data analytics and end-to-end transparency around drug costs. It will help them better comply with the changing regulatory environment. This in turn is expected to augment the growth of the pharmacy benefit management market. Today, pharmacy benefit management is at the center of the pharmaceutical supply chain, acting as mediators between pharmacies, pharmaceutical companies, and payers.
Such platforms are responsible for processing the majority of prescriptions written in the U.S. by prescribers annually. For example, in February 2021, RxParadigm, a new company, was launched to restore drug industry competitiveness, reduce the costs of prescription drugs, and increase the availability of life-saving therapeutics to Americans. A major population in the U.S. receives healthcare benefits from their employers. Therefore, employers opt for pharmacy benefit management to reduce their costs. The providers also manage the prescription drug claims i.e. act as a link between the payers and health insurers.
Moreover, the pharmacy benefit management services use various tools such as drug utilization review, disease management, manufacturer’s discount, e-prescribing, drug formulary, mail-service pharmacies, pharmacy networks, and pharmacy discount cards to reduce or manage the cost of prescription drugs, as well as help improve the customer value. Furthermore, with the introduction of costly drugs/treatment for chronic diseases such as cancer, there is an increasing demand for pharmacy benefit management, worldwide. This in turn is expected to propel the pharmacy benefit management market growth.
However, stringent rules and regulations and reluctance to adopt pharmacy automation systems are some major factors expected to restrain the pharmacy benefit management market growth.
Top Key Players Include In Pharmacy Benefit Management Market: Express Scripts, CVS Caremark, Prime Therapeutics, United Health / OptumRx, Catamaran Corporation, Humana Pharmacy Solutions and MedImpact
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