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The Dose

Experts Examine the PBM Industry and its Impact on Prescription Drug Prices – Part Three

by John Norton | Mar 02, 2018

In the first two parts of this blog series, I provided an overview of two panels held at a fall 2017 forum called "Principles for Patient-Centered Prescription Drug Coverage," that identified problematic PBM business models and discussed potential solutions. For the keynote, Dr. Mark Fendrick, director of the Center for Value Based Insurance Design at the University of Michigan discussed efforts to create a better system for delivering health care to patients by encouraging and implementing more efficiency, coordination, and proactive care that includes prescription drugs as part of the solution (The highlighted video is 18 minutes long). According to Fendrick, investment in upfront health care spending is critical to producing better results. For Fendrick, implementing value-based care (reducing low value care) is the best way to limit waste and produce better health outcomes.

By being more targeted, Fendrick argues that the industry can eliminate $600 to $900 billion dollars of unnecessary spending from the system. For example, cost-related non-adherence is a huge driver in patients not maximizing their drug regimens. If the payment model focused on the results that could be delivered to the patient, patients would be incentivized to improve adherence. According to Fendrick, a more patient-centric approach will yield better results. Such an approach requires greater collaboration throughout the health care delivery system and a greater reliance on metrics to help guide the decision-making process.

Take time to watch his presentation.