Kirby Bessant Vice President, Consumer Programs

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Presentation transcript:

Kirby Bessant Vice President, Consumer Programs Medicare Prescription Drug Discount Card Program: The Role of PBMs and Other Third-Parties Pharma Congress Audioconference Jan. 27, 2004

Role of PBMs Support Health Plans, Third Parties As: Drug discount negotiator Pharmacy network coordinator Home-delivery prescription provider Service administrator Drug utilization review facilitator

PBMs to Partner with Clients to Support Their: Medicare+Choice offerings (health plan only) Medicare-endorsed programs

Role of PBMs: Drug Discount Negotiator Secure discounts from retail pharmacies Negotiate discounts from drug manufacturers Provide cost savings through mail service

Role of PBMs Discount Card Study Findings Save cardholders 11% on 17 common drugs used by seniors (GAO1) Save hundreds of dollars per year for patients on multiple drugs (Brandeis University2) with average discounts being: 26% ($7 per Rx) on generic drugs 14% ($11 per Rx) on brand drugs Save cardholders 10% to 15% off a retail pharmacy’s price (GAO3) Sources: 1 Rx Drugs: Prices Available Through Discount Cards and from Other Sources, GAO Dec. 2001. 2PBM-Administered Prescription Drug Discount Cards: Savings for Uninsured Seniors, Brandeis University Schneider Institute for Health Policy, March 2003. 3Prescription Drug Discount Cards: Savings Depend on Pharmacy and Type of Card Used, GAO Sept. 2003

Role of PBMs: Pharmacy Network Coordinator Develop and maintain large national networks of retail pharmacies Customize local, regional networks of retail pharmacies

Role of PBMs: Home-Delivery Prescription Provider Provide convenient mail-order prescriptions Ideal for maintenance drug programs Access via phone and Internet Access to clinical staff

Role of PBMs: Service Administrator Develop members communication materials Enroll new members Serve members’ ongoing needs Process prescription claims Provide reports

Role of PBMs: Drug Utilization Review Facilitator Send electronic pharmacy messages Alert pharmacies to potentially dangerous drug interactions Improve patient safety