» Update on the PBM Market
August 21, 2023
Acrisure, Captives, Employee Benefits, Healthcare, Healthcare Innovation, Healthcare Spending, Prescription Drugs
Last week, Blue Shield of California announced the end of a 15-year partnership with CVS Health’s pharmacy benefits manager Caremark, in favor of new partnerships to provide access to affordable prescription drugs. For now, Blue Shield is betting on a predicted $500M in annual savings by switching to Mark Cuban Cost Plus Drugs Company (MCCPDC) for low-cost meds through retail pharmacies and Amazon Pharmacy for at-home delivery.
Blue Shield’s decision highlights a growing trend in the healthcare industry, where payers like insurance companies are looking for innovative solutions to reduce costs and improve access to medications for their customers. By partnering with MCCPDC for low-cost medications through retail pharmacies and leveraging Amazon Pharmacy for at-home delivery, Blue Shield is taking a unique approach to providing prescription drugs to its members.
Mark Cuban Cost Plus Drugs Company (MCCPDC) appears to be positioning itself as a provider of affordable medications, possibly by using a cost-plus pricing model, where a fixed markup is added to the actual cost of the drug. Amazon Pharmacy, on the other hand, is known for its efficient online delivery platform and has been working on initiatives to increase affordability in the prescription drug space.
The move away from traditional pharmacy benefits manager (PBM) relationships indicates that payers are seeking alternatives to address concerns over high drug prices. PBMs have faced scrutiny in recent years for their role in the complex drug pricing ecosystem. This development could potentially influence how other payers and healthcare organizations approach their partnerships with PBMs in the future.
The success of this new partnership between Blue Shield, MCCPDC, and Amazon Pharmacy will likely be closely monitored by the healthcare industry. If these entities can deliver on their promises of affordability and scale, it might encourage other payers to explore similar models to control drug costs and improve access for their members. This shift could potentially disrupt the traditional channels and dynamics between payers and PBMs.
Additionally, the impact on consumers and their savings is a key aspect to watch. If the partnership does indeed result in significant annual savings as predicted, it could lead to improved consumer satisfaction and potentially set a precedent for more transparent and cost-effective prescription drug options. Overall, this development highlights the ongoing evolution of the healthcare industry as stakeholders seek innovative solutions to address the challenges of high drug prices and access to medications.
To learn more about high cost drugs and cost containment, sign up for our upcoming webinar series!
| The sessions of Developments in the Southwest Region Webinar Series include: | ||
| Funding Strategies:
Speakers: Doug Gray President The Benefits Group Rob Hamilton EVP of Sales Roundstone |
High Cost Strategies
Speakers: Aaron Searls VP of Business Development True RX Health Strategies |
Healthcare, benefits and the evolving legislative landscape
Speakers: VP, Head of Govt Relations Sun Life |
| Attendees at each session will be entered to win one of three $100 gift cards and individuals who attend all three sessions will be entered to win one of four $250 gift cards. | ||
Posted by John Hansbrough in Acrisure, Captives, Employee Benefits, Healthcare, Healthcare Innovation, Healthcare Spending, Prescription Drugs