Unique to the U.S., the Pharmacy Benefit Management (PBM) industry manages the prescription drug portion of health insurance plans for 266 million consumers. In the U.S., three PBMs control 78 percent of the market, says Accenture. According to their thought piece, A Tough Pill to Swallow, PBMs will have to adapt to health trends: digital health / personalization; and delivery of quality outcomes; and industry consolidation. Accenture argues that PBMs “can redefine the role they play” in the system, lead with value-based reimbursement strategies, and get closer to their patients by enhancing other stakeholders’ digital strategies.
A unique industry in the ecosystem of U.S. healthcare, PBMs will face the challenge of becoming relevant to multiple stakeholders who are all affected by the same trends. Even though PBMs themselves are consolidated, they face challenges from provider and insurer consolidation. Moreover, the digital trend signals the importance of individual patient consumers and “outcomes” rather than pure volume. PBMs need to avoid the perception that they are distributing commodities and instead bringing in a unique and measurable source of value.