Press Releases

PBMI Survey Shows Employers Are Pressed to Make Tough Decisions to Curb Specialty Drug Costs

Plano, TX (GlobeNewswire, March 8, 2017) – Twenty-seven percent of employers are using a high deductible plan with coinsurance as part of their specialty drug benefit, according to the 2017 Trends in Specialty Drug Benefit Report published by the Pharmacy Benefit Management Institute (PBMI). Although this strategy helps to lower insurance premiums, it can come at a price of members not following their prescribed drug therapy regimen due to affordability.  The report, sponsored by Walgreens for the sixth year, was released yesterday at PBMI’s 22nd Annual Drug Benefit Conference and includes responses from 298 employers representing 10 million covered lives.

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PBMI Honors Six Organizations with Excellence Awards 

Plano, TX (GlobeNewswire – March 7) – The Pharmacy Benefit Management Institute (PBMI) will award six organizations with their 2017 Excellence Award today at their 22nd Annual Drug Benefit Conference in Orlando, Florida.  Each organization is recognized for exceptional programs and strategies contributing to cost containment, care management, and quality improvement for the drug benefit.   

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PBMI Report Shows Changes in Pharmacy Benefit Design to Meet Cost Challenges

PBMI Releases 2016 Trends in Drug Benefit Design Report

Plano, TX (Marketwired - December 12, 2016) ―Although employers continue to cite managing drug cost trend as the number one goal, they are addressing this challenge head on by implementing significant changes in drug benefit design.  This is just a sampling of the results from PBMI’s 2016 Trends in Drug Benefit Design Report released today.  The report includes responses from 337 benefit leaders representing employers with an estimated 12.3 million covered lives.

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PBMI’s 2016 Report Shows a Slight Increase in Overall Satisfaction Scores with PBM Services

PLANO, TX—(Marketwired- October 20, 2016) – Overall satisfaction with PBMs continues to hold relatively steady with a slight increase from 7.7 in 2015 to 7.8 in 2016. This is just one of the results from PBMI’s 2016 PBM Customer Satisfaction Report, released today. The report includes responses from 507 benefit leaders representing employers providing drug benefit coverage for an estimated 54.7 million covered lives.

“Our research shows that PBMs who can deliver high quality services, have aligned goals with clients, and help maintain employee and member satisfaction in turn have highly satisfied customers,” says Jane Lutz, Executive Director of PBMI. “In the competitive PBM marketplace, customer satisfaction is a key differentiator. Highly satisfied customers are more likely to renew services with their current PBM and even refer potential customers to their existing PBM.” Read full story


PBMI Survey Shows Employers Are Concerned, But Striving To Sustain A Valued Specialty Drug Benefit

PLANO, TX–(Marketwired – Mar 4, 2016) – The Pharmacy Benefit Management Institute (PBMI) released the results of its fifth annual Trends in Specialty Drug Benefits Report at its 21st Annual Drug Benefit Conference in Palm Springs, California. Results show that employers are concerned about the rising costs of specialty drugs, but continue to strive to provide valued drug benefits for employees. The report includes responses from 341 employers covering an estimated 14.5 million lives.

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PBMI Announces Six Organizations As Winners Of Its Inaugural Excellence Award

PLANO, TX–(Marketwired – Mar 1, 2016) – The Pharmacy Benefit Management Institute (PBMI) announced the winners of its Excellence Award at the 21st Annual Drug Benefit Conference today. Six organizations were recognized for exceptional contributions across the pharmacy management continuum in the areas of care management strategies, cost containment, and quality improvement.

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Learn Best-In-Class Strategies For Successful Pharmacy Benefit Management At PBMI’s 2016 Conference

Plano, TX – (Marketwired, January 28, 2016) – The Pharmacy Benefit Management Institute (PBMI) will host its 21st Annual Drug Benefit Conference in Palm Springs, California February 29 – March 2, 2016 at the Westin Mission Hills Golf Resort & Spa. The conference kicks off with a keynote address from Dr. Daniel Kraft “The Future and Health of Medicine: Where Can Technology Take Us?” followed by more than 20 educational sessions, and two free pre-conference workshops. PBMI will also be announcing winners of a new Excellence Award to recognize exceptional contributions across the pharmacy management continuum in the areas of cost containment, quality improvement, and care management strategies.

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PBMI Launches Industry’s First Pharmacy Trends In Accountable Care Organizations Report

PLANO, TX – (Marketwired – Jan 25, 2016) – The Pharmacy Benefit Management Institute (PBMI) released today the industry’s first report examining pharmacy trends in Accountable Care Organizations (ACOs). More than one hundred providers representing 6.5 million enrollees were surveyed. With the addition of this report, PBMI now publishes four national industry trend reports to help health care stakeholders stay on top of marketplace and emerging drug benefit trends and management challenges.

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PBMI Survey Shows Employers Continue To Face Uphill Battle With Rising Drug Costs

Plano, TX – (Marketwired, December 14, 2015) – Last year marked a dramatic increase in medication cost trend for employers according to The Pharmacy Benefit Management Institute’s (PBMI) fifteenth annual Drug Benefit Report released today. Traditional prescription trend increased from 2.4% to 6.2% and specialty trend increased from 12.2% to 19.2%. Cost increases were likely driven by utilization of specialty medications, especially new drugs to treat conditions such as hepatitis C, as well as overall price inflation. The report includes responses from 302 employers representing 16.3 million members.

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PBMI’s 2016 Report Shows a Slight Increase in Overall Satisfaction Scores with PBM Services

PLANO, TX—(Marketwired- October 20, 2016) – Overall satisfaction with PBMs continues to hold relatively steady with a slight increase from 7.7 in 2015 to 7.8 in 2016.  This is just one of the results from PBMI’s 2016 PBM Customer Satisfaction Report, released today.  The report includes responses from 507 benefit leaders representing employers providing drug benefit coverage for an estimated 54.7 million covered lives. 

“Our research shows that PBMs who can deliver high quality services, have aligned goals with clients, and help maintain employee and member satisfaction in turn have highly satisfied customers,” says Jane Lutz, Executive Director of PBMI. “In the competitive PBM marketplace, customer satisfaction is a key differentiator. Highly satisfied customers are more likely to renew services with their current PBM and even refer potential customers to their existing PBM.”

The following outlines key highlights from the report:

  • Eighty-three percent of plan sponsors say their PBM is aligned with their goals.
  • Average ratings across the service dimensions remained relatively the same. No conflict of interest issues ranked the highest (8.2) similar to last year, while flexibility dropped from a 7.5 score in 2015 to 7.3 in 2016.
  • Ninety-one percent of respondents feel that their financial relationship is somewhat or completely transparent.
  • Five of the nine rated PBM functions scored 8.0 or higher, with retail network options receiving the highest rating (8.5).
  • Slightly more than 0.5 points separated the highest (formulary management) and lowest (consumer education tools) rated noncore services.
  • Delivery of promised services and utilization management received a top score of 7.9 for specialty management dimensions and functions.
  • Plan sponsors rate their likelihood to renew an 8.1.

The 2016 PBM Customer Satisfaction Report is available in electronic format for purchase. This year’s report includes profiles for 11 PBMs. Purchase your copy today.

About The Pharmacy Benefit Management Institute (PBMI)
PBMI is an independent research and educational organization dedicated to unraveling the complexities of pharmacy benefit management.

Press Release Contact: 
Julie Blackman
480-730-0814
jblackman@pbmi.com


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PBMI Survey Shows Employers Are Concerned, But Striving to Sustain a Valued Specialty Drug Benefit

PLANO, TX–(Marketwired – Mar 4, 2016) – The Pharmacy Benefit Management Institute (PBMI) released the results of its fifth annual Trends in Specialty Drug Benefits Report at its 21st Annual Drug Benefit Conference in Palm Springs, California. Results show that employers are concerned about the rising costs of specialty drugs, but continue to strive to provide valued drug benefits for employees. The report includes responses from 341 employers covering an estimated 14.5 million lives.

“With the pipeline full of specialty medications, it’s no surprise that employers continue to spend more time on specialty drug management,” says Jane Lutz, Executive Director of PBMI. “While many employers report having or evaluating separate cost-sharing tiers and formulary exclusions as part of their benefit design strategy, several opportunities still exist on the medical benefit.”

Key findings from this report include:

  • Specialty drug cost trend and reducing inappropriate utilization remain the top two benefit design goals.
  • Fifty-four percent of smaller employers cover specialty drugs under the pharmacy benefit, while larger employers cover these drugs under both medical and pharmacy benefits.
  • Nearly one-third of respondents are planning to implement a separate cost-sharing tier for specialty drugs.
  • Larger employers purchase stop loss insurance much less often (63%) than smaller employers (95%).Average coinsurance increased from 29% to 33% for percentage cost-sharing designs under the pharmacy benefit.
  • Employers are uncertain about the effectiveness of formulary exclusions for managing specialty trend and note member dissatisfaction and clinical disruption as key challenges.
  • Specialty formulary exclusions are most common for growth hormones, cholesterol, fertility, hepatitis C, and multiple sclerosis. Value-based pricing models are catching the attention of employers with 82% expressing interest.
  • Opportunities exist for increasing the use of specialty management programs in the medical benefit:
  • Twenty-nine percent of employers do not have a prior authorization program in place.
  • Forty-one percent do not have clinical care management programs.
  • Less than half (46%) have step therapy in place.

Click here to order the report.

About PBMI
The Pharmacy Benefit Management Institute provides research and education to help health care and benefits professionals work with pharmacy benefit managers to design prescription drug benefit programs.  

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PBMI Announces Six Organizations As Winners Of Its Inaugural Excellence Award

PLANO, TX–(Marketwired – Mar 1, 2016) – The Pharmacy Benefit Management Institute (PBMI) announced the winners of its Excellence Award at the 21st Annual Drug Benefit Conference today. Six organizations were recognized for exceptional contributions across the pharmacy management continuum in the areas of care management strategies, cost containment, and quality improvement.

“PBMI is dedicated to awarding organizations for their contributions in promoting innovative and best-in-class strategies that address cost challenges of prescription drug management, improve the quality of healthcare, and provide clinically appropriate care for members and their families,” says Jane Lutz, Executive Director of PBMI. “With a record number of submissions this year, we are honored to be able to recognize six organizations across the industry.”

Winners by category include:

Care Management Strategies Category
Duke University and Health System:
Duke University and Health System is recognized for its program to meet the challenges of a dynamic health care environment where costs are rising, regulations flourish, and it is more important than ever to ensure the right clinical decisions are made for prescription drug benefits. Working with their PBM, they hired a dedicated, full-time clinical pharmacist to work closely with their Benefits office. The clinical pharmacist developed relationships with prescribers to increase awareness of opportunities for cost-effective prescribing and help them navigate formulary changes saving the plan $7.72 million. Additionally, the clinical pharmacist worked with the PBM to develop and implement programs to reduce out of pocket costs for patients and improved medication adherence.

Manatee “YourChoice” Health Plan
Manatee “YourChoice” Health Plan is an employer-sponsored self-insured plan for Manatee County, Florida Government employees, and is recognized for its in-house Specialty Medication Management Program. A Pharmacy Advocate, staffed by a clinical pharmacist, provides one-on-one pharmacy case management for members using specialty medications. The Pharmacy Advocate plays an integral role in managing the logistics of meeting both prescriber and the patients’ specialty medication needs including managing prior authorization, identifying possible opportunities for dose titration or less expensive therapeutics options, and providing patient education, and counseling. This program has contributed to a 27% avoidance in specialty drug costs.

Cost Containment Category
Truveris:
Truveris is recognized for OneRx®, a free, consumer-friendly, prescription benefits and savings application. This comprehensive consumer prescription tool provides information on drug coverage at the point of care, current out-of-pocket drug prices based on location, and allows consumers to take advantage of savings from discounts and discounts that are available. Truveris has found that members who use the OneRx app make positive changes in their medication purchasing behaviors, choosing lower cost pharmacies and increasing adherence to important medications. Savings of 8% to 25% have been achieved, depending on plan design.

Express Scripts:
Express Scripts is recognized for its Hepatitis Cure Value Program®, which not only ensured access to a cure for Hepatitis C patients but also produced savings for plan sponsors served by Express Scripts. Additionally, Express Scripts helped to elevate the discussion around fair drug pricing for a high cost, specialty chronic disease nationally, resulting in an estimated health care savings across the nation of $4 billion in 2015.

Quality Improvement
Inland Empire Health Plan (IEHP):

IEHP, a non-profit health plan located in southern California, is recognized for its Pharmacy Pay for Performance (P4P) Program. The P4P program leverages retail pharmacists to lower costs and improve the quality of care for IEHP members. Using prescription-based quality measures aligned with medication adherence and patient safety to measure network pharmacy performance, overall improvement from 2013 baseline measures have been achieved. The P4P program is also credited with improvement in pharmacy provider engagement and overall commitment to quality improvement initiatives.

OptumRx:
OptumRx is recognized for its BriovaLive™ Specialty Pharmacy Video Consultation Program. BriovaLive enables patients to schedule private appointments with a BriovaRx specialty pharmacist via webcam, on any type of device, from the comfort of the patient’s home. Patients who participated in the BriovaLive support program were significantly more likely to be adherent to their medications than those who did not participate. Ninety-six percent of participating patients reported that they better understood how to use their medications because of the program.

About PBMI
The Pharmacy Benefit Management Institute is dedicated to unraveling the complexities of pharmacy benefit management by providing research, continuing education, and Web resources that help organizations work effectively with their pharmacy benefit managers to improve the overall management of drug benefit programs. 

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Learn Best-In-Class Strategies For Successful Pharmacy Benefit Management At PBMI’s 2016 Conference

Plano, TX – (Marketwired, January 28, 2016) – The Pharmacy Benefit Management Institute (PBMI) will host its 21st Annual Drug Benefit Conference in Palm Springs, California February 29 – March 2, 2016 at the Westin Mission Hills Golf Resort & Spa. The conference kicks off with a keynote address from Dr. Daniel Kraft on “The Future and Health of Medicine: Where Can Technology Take Us?” followed by more than 20 educational sessions, and  free pre-conference workshops.

PBMI will also be announcing winners of a new Excellence Award to recognize exceptional contributions across the pharmacy management continuum in the areas of cost containment, quality improvement, and care management strategies. “Plan sponsors continue to be challenged with the rising costs of prescription drugs and the full pipeline,” says Jane Lutz, Executive Director of PBMI. “Our Annual Drug Benefit Conference is a great venue for employers, health plans, labor groups, and others in the benefits industry to learn about best-in-class strategies for successful pharmacy benefit management.”

After participating in the conference, attendees will be able to understand and act on:

  • Appropriate management strategies for the specialty drug benefit (including new drug therapies, transparency, and biosimilars)
  • Best practices from accountable care organization (ACO) models and medication management programs
  • Effective strategies for managing compounded medications
  • Key issues in the workers’ compensation arena (including legislation and preventing opioid abuse)
  • Effective approaches for managing the traditional drug benefit (including medication adherence, transition of care, and integration of pharmacy, medical, and lab data)

About PBMI
The Pharmacy Benefit Management Institute is dedicated to unraveling the complexities of pharmacy benefit management by providing research, continuing education, and Web resources that help organizations work effectively with their pharmacy benefit managers to improve the overall management of drug benefit programs. 

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PBMI Launches Industry’s First Pharmacy Trends In Accountable Care Organizations Report

PLANO, TX – (Marketwired – Jan 25, 2016) – The Pharmacy Benefit Management Institute (PBMI) released today the industry’s first report examining pharmacy trends in Accountable Care Organizations (ACOs). More than one hundred providers representing 6.5 million enrollees were surveyed. With the addition of this report, PBMI now publishes four national industry trend reports to help health care stakeholders stay on top of marketplace and emerging drug benefit trends and management challenges.

“ACOs represent a critical and growing part of the solution to help improve value, quality, and care in our nation’s health care and pharmacy plays an important role in achieving those goals,” says Jane Lutz, Executive Director of PBMI. “Our new ACO report looks specifically at valuable information regarding contract and financial incentive structures, current practices in pharmacy management, and plans for the future.”

Key findings from PBMI’s inaugural Pharmacy Trends in ACOs report include:

  • The pharmacist role in ACOs is underutilized, with only 57% of respondents currently employing or contracting with clinical pharmacists.
  • Managing population health is cited as very or extremely important by 93% of respondents and 98% believe the focus on population health will increase in the next three to five years.
  • Clinical integration of systems varies across the board. Less than a third of respondents are on a single electronic medical record (EMR) system; 59% are on multiple systems, while 23% use paper charts.
  • Most respondents utilize support tools (90% – quality reporting tools, 60% – point of care decision tools) yet only 34% find them easy to use.
  • Improving adherence and persistency, reducing inappropriate utilization, and drug selection that improves clinical outcomes are the top three goals for managing medications.

Click here to order the report.

About PBMI
The Pharmacy Benefit Management Institute provides research and education to help health care and benefits professionals work with pharmacy benefit managers to design prescription drug benefit programs.  

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PBMI Survey Shows Employers Continue To Face Uphill Battle With Rising Drug Costs

Plano, TX – (Marketwired, December 14, 2015) – Last year marked a dramatic increase in medication cost trend for employers according to The Pharmacy Benefit Management Institute’s (PBMI) fifteenth annual Drug Benefit Report released today. Traditional prescription trend increased from 2.4% to 6.2% and specialty trend increased from 12.2% to 19.2%. Cost increases were likely driven by utilization of specialty medications, especially new drugs to treat conditions such as hepatitis C, as well as overall price inflation. The report includes responses from 302 employers representing 16.3 million members.

“We are pleased to release the next version of our Drug Benefit Report which highlights the fact that employers continue to struggle to meet the challenges of rising drug costs,” says Jane Lutz, Executive Director of PBMI. “With the patent cliff and generic cost savings opportunities behind us, employers are forced to take a more creative, targeted approach to be more prepared for the pipeline filled with higher cost medications.”

Key findings from the report include:

  • Cost-sharing has become more complex and targeted over the past five to ten years. Four-tier structures were used by 28% of respondents, compared with 8% in 2008.
  • Although average retail 30 copay amounts for generics and preferred brands remain stable, preferred brand copay amounts have approximately doubled in the last 15 years from $37.58 to $56.65, adjusted for inflation.
  • Use of pharmacy only deductibles increased 157% in 2015 compared to 2014 and 36% of plan sponsors now report having a deductible for prescription drugs compared to 14% last year.
  • When appropriate, opportunities exist for plans to implement strategies that decrease out-of-pocket (OOP) costs for members through increased use of mandatory mail order or retail 90 for maintenance medications.

PBMI will host a free, live webinar on December 16 at 1:30 pm EST to showcase the results of this report.

To request a printed copy or download a copy of this report click here.

About PBMI
The Pharmacy Benefit Management Institute provides research and education to help health care and benefits professionals work with pharmacy benefit managers to design prescription drug benefit programs. 

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