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.

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. 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. 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. 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. 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. 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. 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
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