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A Tough Pill to Swallow: Pharmacy Benefit Managers Must Adopt A New Model

Prescription drug costs make up nearly 10% of US healthcare spending. Much of that spending is allocated to Pharmacy Benefit Managers (PBMs) — the behind-the-scenes companies that administer prescription drug benefits for 266 million consumers.

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A Tough Pill to Swallow: Pharmacy Benefit Managers Must Adopt A New Model

  1. 1. Copyright © 2016 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. A tough pill to swallow: Pharmacy Benefit Managers must adopt a new model before time runs out
  2. 2. Big players on a big stage. Prescription drug costs make up nearly 10% of US healthcare spending. Much of that spending is allocated to Pharmacy Benefit Managers (PBMs) — the behind-the-scenes companies that administer prescription drug benefits for 266 million consumers. Copyright © 2016 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.
  3. 3. Copyright © 2016 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. On the fast track to irrelevance. While PBMs have played a critical — and profitable — role in the healthcare industry for decades, their relevance is now at risk. That’s because most PBMs haven’t kept pace with the changing healthcare ecosystem of which they are a part. If they don’t change their operating models, they won’t be positioned to claim their share of a rapidly growing market. • In 2014, the PBM market was valued at $263 billion. By 2019, it is forecast to grow to $283 billion.
  4. 4. Copyright © 2016 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. Two market shifts pose a significant risk. Insurers rely on personalized technologies to monitor drug adherence and improve patient health. The use of personalized health apps and wearables has doubled in the past two years. • 70% of health executives are investing more in embedded artificial intelligence solutions. Yet, for PBMs, it is largely “business as usual.” 1. Growing demand for digital experiences
  5. 5. Copyright © 2016 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. Two market shifts pose a significant risk. PBM constituents want more than a cost-focused intermediary. They want a partner to help them deliver better outcomes. Yet, PBMs aren’t meeting expectations. • Patient satisfaction across the PBM experience ranges from 65-75%. That’s hardly a ringing endorsement. 2. The industry’s focus on quality outcomes
  6. 6. Don't treat the symptoms. Cure the disease. To survive, PBMs must establish a differentiated operating model that will enable them to deliver services in a differentiated way. PBMs should act now to embrace these five imperatives: • Become outcome champions by building capabilities that allow them to contribute to positive patient outcomes. • Redefine their worth by launching value-based reimbursement strategies. • Be disruptive by getting closer to employees and consumers. Loyalty programs may help. • Architect new — and more valuable — experiences by embracing digital opportunities to deliver experiences that their constituents want and expect. • Form unconventional partnerships with others in “ecosystems” to drive operational efficiencies and provide more or differentiated constituent experiences. Copyright © 2016 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.
  7. 7. LEARN MORE about how PBMs can deliver value with our full report: Copyright © 2016 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. A tough pill to swallow: Pharmacy Benefit Managers must adopt a new model before time runs out @AccentureStrat Follow us on Linkedin

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