U.S. PBM usage on the rise due to increasing drug costs

A U.S. study released by Buck Consultants indicates that the use of third-party pharmacy benefit managers (PBMs) has increased by 10% in the past two years (47% in 2009 to 57% in 2011).

With 67% of respondents citing pharmaceutical pricing as “‘highly important ” more and more employers are using PBMs to process and pay prescriptions because they offer better drug prices.

“Strong competition among PBMs for employer business has created a buyer’s market for PBM pricing, and we expect this competition will intensify as health care reform is implemented,” said Michael Jacobs, principal and national clinical practice leader at Buck Consultants. “Therefore, employers can be aggressive in their negotiations with PBMs.”

Drug costs still rising
Pharmacy benefit costs currently represent more than 15% of employers’ total healthcare costs. Specialty medications used to treat chronic illnesses are typically used by only 1% or less of covered employees, but represent 15% or more of drug plan costs.

“Specialty drugs will be the major driver of pharmacy cost increases over the next three to five years,” said Michael Jacobs, principal and national clinical practice leader at Buck Consultants. “We anticipate specialty drugs will represent upwards of 30% of drug costs within the next three or four years.”

Better cost management needed
Despite the rising cost of these drugs, 33% of respondents did not know the percent of overall drug spend attributed to specialty medications.

With 96% respondents providing employees with prescription drug coverage the need for better drug costs continues to increase, as does the need for better education in managing drug benefits costs.

More than 220 organizations participated in the survey, representing a broad range of industries and more than 2.5 million full-time employees.