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Jun 29, 2021
Meaningful Growth Expected from Pharmacy Solutions Organizations

Developing a vaccine in under a year is no easy feat.

The unprecedented pace of development for the COVID-19 vaccines demonstrates the ability of the pharmaceutical industry to deliver breakthrough medications and innovations at accelerated speed. However, the availability of a medication or therapy is just the starting point. According to a newly-published Cigna white paper, work across the health care ecosystem must be done to ensure they are delivered to the correct patients, at the right time, in the appropriate setting and at affordable costs.

Pharmacy solutions organizations—traditionally known as either pharmacy benefit managers (PBMs) or health services organizations—will play an expanding role to deliver these breakthrough medications and therapies to those who need them. The role of the pharmacy solutions organization is critical given that, on their own, many health care payers (e.g., health plans, employers, and government entities) are ill-equipped to manage the complex distribution chain of pharmaceuticals to ensure affordable access to medication. Affordability is especially important today as the expansion of high-cost specialty medications and gene and cell therapies drive exorbitant expenses for the health care system.

Health care payers also look to pharmacy solutions organizations to provide the ongoing patient touchpoints to help patients properly take their medications as prescribed over time. This objective will become more challenging, given the surging demand of chronic care prescriptions among the aging population. Fifty percent of older Americans have at least two chronic conditions and 39% take five or more prescriptions at any one time.

“[Organizations like] PBMs negotiate drug benefits on behalf of insurance companies, large employers, unions, state Medicaid programs, and other large buyers of prescription drugs,” according to Ike Brannon, Senior Fellow of the Jack Kemp Foundation, and Tony LoSasso, Professor of Economics at DePaul University. “They are the only mechanism in the drug supply chain mitigating the impact of high drug prices on consumers.” 

Payers have relied on pharmacy solutions organizations to help them achieve the goals of medication affordability and effective treatment options. Pharmacy solutions organizations currently serve more than 266 million people in the United States, and these organizations are on track to save payers and consumers more than $1 trillion in pharmacy costs by 2029 by leveraging and expanding their capabilities to:

  • Drive affordable solutions to help patients access the chronic and breakthrough medications and therapies they need
  • Connect across a fragmented health care system to ensure effective, high-touch, coordinated treatment management
  • Harness patient data to enhance pharmacy treatment and ensure successful outcomes
  • Because of their vital role in ensuring affordable, appropriate and effective care, pharmacy solutions organizations are in a position to experience fervent growth over the next decade.

For more details on how pharmacy solutions organizations make a difference in driving affordability and efficacy in pharmacy treatment, read the white paper.