FALL  2000 
Volume 5 / Number 3

PBMs and Information

PBMI's viewpoint is that access to information is good and that access to more information is better. The PBM industry has improved the quality of the industry and client-specific information produced over the past years. This is reflected in the printed material available and comments from PBM customers in PBMI's annual customer satisfaction survey.

At least three PBMs now produce formal studies of some of the issues that are responsible for the double-digit, annual benefit cost increases that many plan sponsors have experienced. These reports provide detailed insight into what makes up these increases. These reports are generally available to the public.

As new drugs are approved or even before, many PBMs produce fact sheets explaining the mechanisms of action, suggested uses or indications, and whether they should be covered. This information is time-critical as coverage decisions should be made before a large number of patients begin filling prescriptions. These fact sheets are commonly made available by the PBMs only to their customers. However, two PBMs, Caremark and PCS, post these fact sheets on their web sites and allow PBMI to provide links to these pages. Readers can access these web sites from www.pbmi.com.

PBMs also are now beginning to produce studies documenting the results of some of their value-added services. This type of report is particularly useful in helping customers validate their decisions about whether to implement these services. The production of these reports is still relatively infrequent, but is a sign that the PBMs understand these studies are important to the industry's credibility.

Most large clients now receive annual reports from their PBMs that go beyond a simple recitation of utilization statistics. These reports combine text, data, and graphics to present a more compelling picture of the client's utilization. These reports, along with personal presentations by PBM support staff, are useful in helping clients decide whether additional management interventions are warranted, if they are possible, and detail potential savings.

Not all PBMs are able to provide all of these services. In the case of book of business cost increase trend analyses, absent some glaring oversight, more analyses of this type would be redundant. PBMs that do not produce these reports should not be considered inferior. However, communicating about new drugs and providing consulting services and supporting reports about utilization experience have become relatively standard and are a very valued service. These should become a requirement.

Outcomes studies are a little more problematic. These studies are very time-consuming, difficult, and expensive to perform. Not every PBM has the resources to perform these studies. However, if the industry expects their claims of cost savings to be believed, PBMs need to begin documenting and publishing their results.

The PBM industry is maturing and the improved quality of information being generated is a good sign. Be sure to ask your PBM for the information you need.

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