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Shelly Reese is a freelance writer based in Cincinnati, Ohio. She is a frequent contributor to Managed Healthcare Executive.
The bad news: PBMs have the weakest performance on the aspects that matter most to employers.
ACCORDING TO a Pharmacy Benefit Management Institute (PBMI) annual survey, employers are satisfied with the services of their pharmacy benefits managers (PBMs). The bad news: PBMs have the weakest performance on the aspects that matter most to employers.
In fact, since the non-profit began conducting its surveys in 1995, there's been little change in employer satisfaction. But qualities that employers consider the most essential-goal alignment, financial transparency and clinical programs-earned the lowest scores.
However, PBMs have room for improvement on employer-facing issues that relate to goal alignment and financial transparency. Four of the five categories in which PBMs scored the lowest-drug utilization management, formulary management and rebates, management reports and utilization, and benefit management consulting-are measures that relate to employers' sense of partnership with PBMs.
Improving those scores depends on transparency, Felthouse says, and should begin with the request for proposals (RFP) process in contracting. She says that when PBMI asked employers specifically about the RFP process, it found that clarity of the contract language was the factor most strongly associated with an employer's overall satisfaction rating.
"If both parties are clear on the contract, then you've got goal alignment," she says. "You need to start with clear contracts that spell out the financial terms and the scope of the services to be provided. That's the first and biggest step to creating transparency. It's elemental. Employers need to know what they're paying for."
It's virtually impossible for employers to make an apples-to-apples comparison of pharmacy benefits when PBMs don't break down cost data in RFPs.
DM SERVICE REMAINS LOW
Another factor suppressing overall satisfaction scores is disease management, which is consistently the lowest-rated service function, Felthouse says. The average DM rating has increased modestly from 5.9 in 1996 to this year's 6.7 out of a possible 10 points, but the category is always at the bottom, she says.
"There's a huge spectrum of what PBMs will cover as far as disease management, and because there is such variation, it's hard to really know what people are rating and what depth of services they are responding to," Felthouse says.
Because of wide service variations, it's difficult to extrapolate on the data and identify where PBMs need to improve.
Many PBM's disease management programs aren't integrated into employers' overall disease management programs.
"They're focused on the prescription drug therapy piece of disease management, but peer review literature says disease management is most effective when everybody involved in disease management-including pharmacy, disease managers, clinicians and therapists-are all working together," Felthouse says. "PBMs have an important role, but they're just one portion of disease management."
-Shelly ReeseCommentary is independent of source data.