“Manufacturers and PBMs are good at what they do,” says Blasine Penkowski, chief strategic customer officer at Piscataway, New Jersey-based Johnson & Johnson Health Care Systems, which provides contracting, supply chain, business services, and strategic solutions.
Biopharmaceutical companies have delivered innovation in recent years, while PBMs have been effective in containing pharmaceutical costs, she says.
Penkowski cites some statistics to back up her points:
But the current system isn’t working for patients, says Penkowski, who spoke at the Pharmaceutical Care Management Association Annual Meeting, in Scottsdale, Arizona, on September 23 and 24. To wit, commercially insured patients with a deductible saw their out-of-pocket costs for branded medicines increase 48% from 2013 to 2016.
Managed Healthcare Executive (MHE) recently asked Penkowski for her pulse on the manufacturer-PBM relationship.
MHE: What trends are you seeing related to the relationship between manufacturers and PBMs?
Penkowski: We’ve begun to see earlier interactions between PBMs and manufacturers, in preparation for launch. Manufacturers know how critical early communication is in facilitating payer and PBM planning.
Now, thanks to recent FDA guidance, manufacturers can begin sharing scientific information even earlier in the process. Better dialogue can help payers and PBMs plan for what’s coming so that patients can have the right therapy at the right time. This is going to be crucial as cell and gene therapies and other innovative medicines are developed.
We’re also seeing a trend toward combined medical/pharmacy benefit management. In the short term, this gives payers and PBMs greater leverage in the market. In the long term, it presents an opportunity for us all to work together for the patient.
Combined medical/pharmacy benefit management paves the way for value propositions that take into account medical-side outcomes, which include the total cost of care such as hospital readmissions and doctor office visits. Medical-side outcomes can help align incentives in ways that tackle health challenges related to medication management, such as undertreatment, adherence, and abandonment.
MHE: What are some ways PBMs and manufacturers can work together to improve patient health?
Penkowski: First, we need to find a way to address adherence. Over the long term, lack of adherence results in poorer health outcomes and can lead to higher overall system costs. The Congressional Budget Office estimates that for every 1% increase in the number of prescriptions filled by Medicare beneficiaries, spending on medical services decreases by about 0.2%.