Preview: RADAR on Drug Benefits

Smaller PBMs Seem to Fare Better on Customer Satisfaction

May 27, 2021

While client-filed lawsuits against PBMs and regulatory scrutiny of their business models continue to make headlines, a newly released survey finds that plan sponsors’ overall satisfaction with their PBMs is relatively high. But Pharmaceutical Strategies Group’s 2020 Pharmacy Benefit Manager Customer Satisfaction Report also reveals that customer satisfaction of PBMs varies depending on the firms’ size and the type of client being served. PSG, a pharmacy benefits consulting firm, was acquired by EPIC Insurance Brokers & Consultants in February.

“The size of the PBM does make a difference, often in the services that are provided because of scale. It also makes a difference in the types of customers who choose a PBM — so many customers are looking to middle-market, midsized PBMs for more flexibility, where others look to the larger PBMs for perhaps deeper discounts,” Sharon Phares, Ph.D., senior vice president of research and data innovation at PSG, said during a May 25 webinar to discuss the survey’s findings.

While client-filed lawsuits against PBMs and regulatory scrutiny of their business models continue to make headlines, a newly released survey finds that plan sponsors’ overall satisfaction with their PBMs is relatively high. But Pharmaceutical Strategies Group’s 2020 Pharmacy Benefit Manager Customer Satisfaction Report also reveals that customer satisfaction of PBMs varies depending on the firms’ size and the type of client being served. PSG, a pharmacy benefits consulting firm, was acquired by EPIC Insurance Brokers & Consultants in February.

“The size of the PBM does make a difference, often in the services that are provided because of scale. It also makes a difference in the types of customers who choose a PBM — so many customers are looking to middle-market, midsized PBMs for more flexibility, where others look to the larger PBMs for perhaps deeper discounts,” Sharon Phares, Ph.D., senior vice president of research and data innovation at PSG, said during a May 25 webinar to discuss the survey’s findings.

In general, “PBMs with 20 million or fewer members tend to have higher satisfaction ratings than larger PBMs,” Phares said, attributing the difference to both “customers with different needs and expectations from their PBM” and “the services provided by the PBM itself.”

Unlock the full version of this article by subscribing.

Log in | Learn More

Pharmacists Could Keep Expanded Scope of Practice

With Chart: Pharmacists Are Permitted to Administer Vaccines in Every State

May 27, 2021

Some 70% of pharmacists have taken on new job responsibilities — ranging from childhood immunizations and diagnostic testing to patient counseling on care and payment options for their medications — during the COVID-19 pandemic, a survey from CoverMyMeds shows.

This trend toward an expanded scope of practice for pharmacists, which had been building prior to the pandemic, accelerated with federal and state actions to relax restrictions in order to improve access to care during the public health emergency, experts say. While pharmacists in some states may lose ground on their practice scope when the emergency ends, it’s likely that more pharmacists will retain the ability to vaccinate children and perform diagnostic tests.

Some 70% of pharmacists have taken on new job responsibilities — ranging from childhood immunizations and diagnostic testing to patient counseling on care and payment options for their medications — during the COVID-19 pandemic, a survey from CoverMyMeds shows.

This trend toward an expanded scope of practice for pharmacists, which had been building prior to the pandemic, accelerated with federal and state actions to relax restrictions in order to improve access to care during the public health emergency, experts say. While pharmacists in some states may lose ground on their practice scope when the emergency ends, it’s likely that more pharmacists will retain the ability to vaccinate children and perform diagnostic tests.

“While the role of the pharmacist has certainly evolved over the past few years, the progression got quite a boost in 2020,” says Kyle Grimslid, Pharm.D., clinical solutions director for CoverMyMeds, which provides software to health insurers to help automate prior authorization processes. “Generally, this evolution is a welcome change for most pharmacists who wish to practice at the top of their license.”

Unlock the full version of this article by subscribing.

Log in | Learn More

Experts: Better Tech May Be Driving More Fraud Detection

May 27, 2021

OptumRx, the PBM subsidiary of UnitedHealth Group, claims that pharmacy waste, fraud and abuse increased in 2020 due to the pandemic — and that independent pharmacies are to blame. While experts won’t rule that out, they also observe that new fraud detection technology might have more to do with the eye-popping findings than any perceived shortcomings of independent pharmacies.

OptumRx tells AIS Health, a subsidiary of MMIT, that pharmacy waste, fraud and abuse increased during 2020. Heidi Lew, Pharm.D., vice president of pharmacy network audit, asserted via email that in 2020, OptumRx:

OptumRx, the PBM subsidiary of UnitedHealth Group, claims that pharmacy waste, fraud and abuse increased in 2020 due to the pandemic — and that independent pharmacies are to blame. While experts won’t rule that out, they also observe that new fraud detection technology might have more to do with the eye-popping findings than any perceived shortcomings of independent pharmacies.

OptumRx tells AIS Health, a subsidiary of MMIT, that pharmacy waste, fraud and abuse increased during 2020. Heidi Lew, Pharm.D., vice president of pharmacy network audit, asserted via email that in 2020, OptumRx:

Recovered nearly $300 million of fraud, waste and abuse spend;

Identified the largest-ever increase of fraudulent claims — more than 300% compared to 2019;

Unlock the full version of this article by subscribing.

Log in | Learn More

Small Business Owners Want Big Changes to Lower Drug Costs

May 27, 2021

Almost 90% of small business owners said the cost of prescription drugs is too high and 63% have an unfavorable view of pharmaceutical companies, according to a recent survey of 1,052 small business owners conducted by the lobbying group Small Business for America’s Future. Among the survey respondents, 66% said the current prescription drug market is in need of a major overhaul and 93% agree that the market needs some changes. Survey respondents supported a variety of solutions to bring down prescription drug costs, with the largest share backing a ceiling for out-of-pocket drug costs for Medicare beneficiaries.

by Jinghong Chen

Almost 90% of small business owners said the cost of prescription drugs is too high and 63% have an unfavorable view of pharmaceutical companies, according to a recent survey of 1,052 small business owners conducted by the lobbying group Small Business for America’s Future. Among the survey respondents, 66% said the current prescription drug market is in need of a major overhaul and 93% agree that the market needs some changes. Survey respondents supported a variety of solutions to bring down prescription drug costs, with the largest share backing a ceiling for out-of-pocket drug costs for Medicare beneficiaries.

Unlock the full version of this infographic by subscribing.

Log in | Learn More

News Briefs

May 27, 2021

In a proposed rule issued on May 26, CMS delayed for six months a provision in a Trump administration-era rule that would have required drug manufacturers to report multiple Medicaid “best prices” connected to a value-based purchasing arrangement. The rule, finalized on Dec. 31, 2020, altered Medicaid “best price” rules — which dictate how rebates are calculated in the Medicaid Drug Rebate Program — by clarifying best price reporting requirements and enabling new models including year-to-year scheduled prices that could change in relation to patient outcomes.

In a proposed rule issued on May 26, CMS delayed for six months a provision in a Trump administration-era rule that would have required drug manufacturers to report multiple Medicaid “best prices” connected to a value-based purchasing arrangement. The rule, finalized on Dec. 31, 2020, altered Medicaid “best price” rules — which dictate how rebates are calculated in the Medicaid Drug Rebate Program — by clarifying best price reporting requirements and enabling new models including year-to-year scheduled prices that could change in relation to patient outcomes.

Unlock the full version of this article by subscribing.

Log in | Learn More