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October 22, 2018
Episode 012

Dr. Geri Bemberg, Vice President and Pharmacy Benefits Analyst at Stephens Insurance, talks about how plan sponsors can maximize the value of health insurance for themselves and their employees with a better understanding of how Pharmacy Benefits Managers work and what’s driving disruption in the industry.

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EVOLUTION OF THE PBM BUSINESS
The role of the Pharmacy Benefits Managers (PBMs) has evolved from one where they simply processed claims for health plans to one where they take a more active role in management of health plans’ prescription drug programs. PBMs generally have contracts with the health insurance plans they service as well as with drug manufacturers and pharmacies. These contracts can be opaque, with plans often unclear about precisely what they are paying for. The contracts also affect everything from what drugs are available to plan beneficiaries, which pharmacies they can use, the cost of drugs, and the rebates that manufacturers pay to plans.

ROLE OF A PHARMACY BENEFITS ANALYST
A pharmacy benefits analyst helps plan sponsors navigate the PBM landscape in an effort to drive plan value. They provide transparency about a PBM’s contracts; help the client understand all the aspects of its own contract with the PBM and identify opportunities to save money while holding the PBM accountable.

DISRUPTION
The implications for plans and beneficiaries of the integration between retail pharmacy chains and insurers as well as the integration of PBMs and health insurers are still unclear. However, this market disruption should be viewed as a teaching point for insurers working with plan sponsors and their members as it allows for immediate and long-term improvements to the benefits offering.

Geri Bemberg




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