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

Membership(s)

Healthcare Payer and Provider Business Process

Sourcing and Vendor Management