Resource developed to raise awareness of PBM quality initiatives and change
the purchaser conversation from “price” to “value”
WASHINGTON – March 27, 2014 – To provide employers with the decision support information needed to manage their pharmaceutical benefits management vendors and programs, the National Business Coalition on Health (NBCH) launched the 2014 NBCH PBM (Pharmacy Benefits Management) Quality Assessment. Almost 30 business health coalitions of employer purchasers from across the U.S. have signed on to date to participate in the program led by the non-profit NBCH.
“Comparing health plan-integrated PBMs with carve-out PBMs is always difficult,” said James Downing, Director, Global Benefits at McCormick & Co., Inc. “This tool can provide an objective apples-to-apples analysis.”
In developing this purchaser decision tool, NBCH surveyed coalitions where 90 percent of respondents indicated they were being asked by employer members for information to help them better manage their PBM programs and vendor selections. The query also found key issues of concern to employers include:
- Increases in pharmacy costs as a percentage of their overall benefits spend.
- Consultants and brokers may be influenced by commissions and purchasing collaboratives.
- Desire to move beyond price-only considerations and into value in making PBM decisions.
- Number of new PBMs entering the industry has created the need to objectively judge their credibility.
- Difficulty in comparing “carve-in” PBMs integrated into the health plans, and “carve-out” PBMs specializing in PBM services.
“Our employer members have asked about the comparative value provided by PBMs,” said John Miller, executive director, Mid-Atlantic Business Group on Health and member of NBCH Board of Governors. “They want to move beyond a pure price discussion and prior to the development of this tool, there wasn’t a resource to look to for objective information on PBM clinical and population health services.”
A variety of PBMs have signed on to participate in the RFI to date, including: Cigna Pharmacy Management, EnvisionRxOptions, OptumRx, and ProCareRx.
Based on the analysis and data from eValue8™, NBCH developed and tested this new PBM Quality Assessment Tool to meet its members’ needs. eValue8 is a comprehensive evidence-based online tool used by coalitions and employers for more than 10 years to objectively measure and compare health plan vendors about how they manage critical processes that control costs and improve health and health care, including PBM services.
Scored by a small team of trained consultants, eValue8 questions are developed and updated by experts based on recommendations and specifications from organizations like the National Quality Forum, PQA, and academic institutions. The PBM Assessment is drawn from the evidence-based PBM measures of eValue8, with minimal additional questions suggested by our PBM experts.
“In an era of health care reform, new PBM models, and complex consulting relationships, employers desire more relevant and unbiased PBM procurement processes”, said Kathi Fairman, vice president at The Pharmacy Benefit Management Institute. “The PBM Quality Assessment Tool will provide employers a more comprehensive evaluation of their PBM options, going beyond the traditional price discounts and allowing for innovative models to emerge.”
Next steps
Responses from participating PBM vendors are due May 16 and scoring will end in June with reports and results being released to participating coalitions and their employer members in July.
About eValue8
eValue8 was created by business coalitions and employers like Marriott and General Motors to measure and evaluate health plan performance. eValue8 asks health vendors probing questions about how they manage critical processes that control costs, reduce and eliminate waste, ensure patient safety, close gaps in care and improve health and health care.
A variety of PBMs have signed on to participate in the RFI to date, including: Cigna Pharmacy Management, EnvisionRxOptions, OptumRx, and ProCareRx.
Based on the analysis and data from eValue8™, NBCH developed and tested this new PBM Quality Assessment Tool to meet its members’ needs. eValue8 is a comprehensive evidence-based online tool used by coalitions and employers for more than 10 years to objectively measure and compare health plan vendors about how they manage critical processes that control costs and improve health and health care, including PBM services.
Scored by a small team of trained consultants, eValue8 questions are developed and updated by experts based on recommendations and specifications from organizations like the National Quality Forum, PQA, and academic institutions. The PBM Assessment is drawn from the evidence-based PBM measures of eValue8, with minimal additional questions suggested by our PBM experts.
“In an era of health care reform, new PBM models, and complex consulting relationships, employers desire more relevant and unbiased PBM procurement processes”, said Kathi Fairman, vice president at The Pharmacy Benefit Management Institute. “The PBM Quality Assessment Tool will provide employers a more comprehensive evaluation of their PBM options, going beyond the traditional price discounts and allowing for innovative models to emerge.”
Next steps
Responses from participating PBM vendors are due May 16 and scoring will end in June with reports and results being released to participating coalitions and their employer members in July.
About eValue8
eValue8 was created by business coalitions and employers like Marriott and General Motors to measure and evaluate health plan performance. eValue8 asks health vendors probing questions about how they manage critical processes that control costs, reduce and eliminate waste, ensure patient safety, close gaps in care and improve health and health care.
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