| Date post: | 16-Apr-2017 |
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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
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 for266 million consumers.
Copyright © 2016 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.
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.
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
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
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.
LEARN MOREabout 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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