Tuesday, January 19, 2010

Health Reform & the PBM Industry

I am pleased to welcome our second sponsor—PCMA’s industry relations web briefing on “Health Reform & the PBM Industry.” This live, online event will be held on Thursday, February 11, 2010, at 2:00 PM EST.

The Pharmaceutical Care Management Association (PCMA) is the national association representing America’s pharmacy benefit managers (PBMs), so this event will be a good opportunity to get a timely update directly from the folks involved in Washington. I have speculated that healthcare reform will be generally positive for PBMs. See Healthcare Reform: Bullish for PBMs, but Not Pharmacies.

Some bad news for eager Drug Channels readers (including me)—the event is open exclusively to PCMA members (view list) or PCMA Affiliates (pharmaceutical manufacturers; view list). The registration fee—free or $95—depends on your company’s sponsor status. See the PCMA registration page for details.


The Health Care Reform legislation being considered in Congress has many potential implications for the PBM industry. Join PCMA for a briefing from the following top policy experts.
  • Mark Merritt, President & CEO, PCMA
  • Kristin Bass, Senior Vice President, Policy and Federal Government Affairs, PCMA
  • Melanie Nathanson, Managing Director, The Glover Park Group
This 90-minute audio webcast will cover the latest information on the health care reform debate and its potential impact on the PBM industry. This is a LIVE event so there will be interactive Q&A with the three speakers.

This event is open exclusively to PCMA Members and Affiliates (manufacturers). Please click here to register now or visit the main event page.

For questions, contact Matt Haller via email or at (202) 207-3620.


  1. Adam,
    Why are you becoming an advertising arm for PCMA? I'm disappointed.

  2. I'm not, so no need to be disappointed. I offered the opportunity to place sponsored ads last November in A New Opportunity to Reach the Drug Channels Audience. I wrote: "I won’t compromise the content for sponsorship." Still true.

    The first two sponsors happen to be IIR and PCMA. However, I welcome support from any legitimate company or organization. Email me for details if you are interested.


  3. Adam,

    To prove that you remain unbiased despite allowing the PCMA to place an ad on your website, how about a critique of a recent PCMA news release touting a study of showing that Kaiser members have improve adherence when they use Kaiser mail order.

    What the PCMA failed to say was that the choice for the Kaiser member was not retail vs mail order, but (far and few between) Kaiser walk-in clinics and hospitals vs mail order.

    See URL below of the of PCMA news release


  4. Here is a link to the full study for interested readers: Mail-Order Pharmacy Use and Adherence to Diabetes-Related Medications.

    The author's conclusions: "Compared with patients who obtained medication refills at local pharmacies, patients who received them by mail were more likely to have good adherence. The association between mail-order use and medication adherence should be evaluated in a randomized clinical trial."

    Your critique seems very technical. It's also highlighted as a limitation on page 39 of the original article, so what's the problem?

    I always encourage people to read original sources and make up their own mind. Also still true.


  5. Adam,

    I'd love to hear your take on this:


    I really want to see you use your pro-PBM (after all, don't bite the hand that feeds you!) spin on this topic.

  6. Sigh

    Remember my motto? "Everyone is entitled to his own opinion, but not his own facts."

    I don't see any source for the Lipitor pricing data cited in table of The Hill article. Looks like the author just made up some numbers, i.e., opinion. I could arbitrarily make up any ol' AWP numbers to tilt the example either way, so it doesn't "prove" anything.

    Show me an actual study (not some unverifiable one-off example) to support the assertions made in the table and I promise that I'll respond.

    And just think for yourself: If PBMs were really earning the margins claimed by this article, wouldn't their reported gross margins would be astronomical? Basic third-grade math should make you skeptical of this article.


  7. BTW, I would be pleased to accept sponsorship from NCPA. Have someone call me and I can discuss rates.

  8. Gosh, I'm an independent druggist at heart and even the above post was pushing things a little hard.


    Sure spread pricing occurs with PBM's, but the repackaging with new NDC's has slowed down tremendously from seven years ago. Big spread pricing occurs primarily with generics as branded products are fixed with a contracted discount off AWP.

    Don't get me wrong, there is room to shave pricing from the PBM, but it should be more focused in the following sectors:

    1. Spread pricing on generics from retail PH.
    2. Rebates obtained from Phrma mfgrs.
    3. Spread pricing on generics from mail order.
    4. Admin fees....shockingly low. A real tipoff that margins are made somewhere else.

    Thanks Adam

  9. This call might be moot now that reform is looking dead.