The Pharmacy Benefits Management (PBM) industry is experiencing significant changes, including increased regulatory scrutiny surrounding pricing transparency and rebate-sharing rules, which are disrupting traditional business models. The rise of specialty drugs is also impacting profitability. Furthermore, the growing adoption of value-based contracting is prompting PBMs to eliminate data silos within their organizations to improve treatment outcomes and detect fraudulent activities. As a result, PBM operating models are shifting and there is a greater emphasis on digitizing operations to improve drug utilization, integrate data, and develop advanced analytical capabilities.
In this viewpoint, we examine the evolution of PBMs, their role in the US pharmaceutical industry, and the key trends and controversies surrounding PBM operations. We also explore potential solutions for addressing PBM challenges and how third-party providers can help alleviate them.
Scope
Industry: healthcare
Geography: North America
Contents
In this report, we:
Examine the role of PBMs in the US healthcare ecosystem
Discuss the key trends and challenges facing the PBM industry
Explore the evolution of the PBM landscape and the role of third-party providers
