The Health-system and the PBM Relationship

By Gregory K. Shaeffer MBA RPh FASHP

In my last post I introduced the opportunities and limitations in the various contracting models with the Pharmacy Benefit Companies (PBMs).

The PBM’s agreement for the Health system provides a significant and real cost savings to the organization’s employee prescription benefit cost to the organization.

The opportunities require two essential components to maximize the programmatic savings for the institution as a part of a comprehensive ambulatory pharmacy strategy.

The first component is an institutional ambulatory pharmacy and a strategy incenting employees and dependents to have their prescriptions filled at the hospital/health system ambulatory pharmacy.

The second component and the focus of this blog is to realize the organizational savings that are achievable and attainable with the hospital and health system’s PBM agreement.  The PBM agreement needs to be transactional and transparent.  Clearly the use of the word “transparency” has been grossly overused in the discussions surrounding PBM contracting.

It is important for hospitals and health-systems to define the philosophy and strategy to achieve the organizational goals.  In subsequent blogs I will explore the continuum of PBM business model contracts and highlight the characteristics of each along the continuum in follow-on articles.