Leveling the playing field in 2022: Changes and opportunities in the PBM landscape




February 8, 2022

 

The PBM landscape continues to evolve rapidly. The last few years have seen dramatic consolidation among PBMs, like Express Scripts, CVS Health, and OptumRx. These “Big 3” PBMs combined share 78 percent of the PBM market.

Simultaneously, though, the reemergence of midsize PBMs and market introduction of new PBM players with specialized offerings and more transparent pricing has helped to level the playing field. Plan sponsors’ frustration with the large PBM consolidation led to re-fragmentation, laying the groundwork for strong competition and opportunities to enhance a PBM relationship.

 


 

Change presents opportunity

Factors like innovative operating platforms, new players, and pricing models tied toward financial transparency mean the PBM landscape is in for transformation like never before. New entries into the market could change the game with a whole new level of healthcare consumerism.

Another driver of change is the growing drug pipeline, loaded with high-priced specialty drugs. With a competitive PBM procurement comes specialty drug management opportunities. Would you like to learn more about four of the most notable opportunities? Download the PSG Complete Playbook to learn more.

 


 

The two great truths of PBM procurements

Plan sponsors receive the most competitive financial terms through the RFP process compared to renewals or non-competitive benchmarking processes.

Plan sponsors significantly benefit from using an independent and impartial consulting of pharmacy experts. Many organizations realize savings of more than 17 percent of their pharmacy spending by working through an independent third party.

 


 

Where should employers start?

Download the 2022 PSG Complete Playbook for Tracy’s recommendations and more on the PBM players and landscape.