Kasey Raetz Highlights PBM Role in Patient Care and Plan Management | PBMI Innovator

As a growing debate about the role of pharmacy benefit managers is in the air, Kasey Raetz, Pharm.D., sees her work as both a responsibility and a point of pride—ensuring patients get timely access to care while helping health plans manage a challenging system.

Raetz is vice president of product and pharma contracting and strategy at Express Scripts and is one of the first winners of Managed Healthcare Executive’s PBMI Innovator Award. The contest highlights leaders who are finding new ways to navigate the complexities of the pharmacy benefit management (PBM) industry.

In the third installment of a video interview series with MHE, Raetz discussed what it means to her to work within a PBM at a time when the industry is under growing scrutiny. She acknowledged the critical role PBMs play in managing drug benefits for health plans, employers and patients.

For Raetz, the work is not only about managing costs but also about making sure patients get the medications they need in a timely manner. She noted that PBMs exist because they help simplify a highly complex system that would otherwise be difficult for payers and patients to navigate.

“I remain proud of everything that we do to help patients deliver the care that they need when they need it and deliver on our commitments to our plans,” she said. “Our employers, our health plans—they hire us to manage this very complicated system and complicated benefit. And we always talk internally; if we weren't doing our job, we would get fired, and we haven't gotten fired, right?”

Her comments reflect the ongoing tension PBMs face between public criticism and their behind-the-scenes role in maintaining access and affordability. By focusing on outcomes for both patients and health plans, Raetz framed the work of PBMs as essential to the healthcare system.

As a PBMI Innovator Award recipient, Raetz is recognized not only for her leadership but also for representing the evolving role PBMs play in responding to both market pressures and patient needs.