Managed Care Matters' 19th annual prescription drug management survey is now on our website.

Jay Stith

Earlier, we discussed which pharmacy benefits manager was seen as best-in-class, customer service and A.I. — all of which are covered in detail in the report.

Something not overly explicit in the survey but a common theme amongst many respondents was a sense of unease.

Overall prescription management is going reasonably well. There was a modest rise in overall spending on prescription drugs (3%), due in part to an increase in claim volume.

High-cost “TV drugs” were noted as driving costs up for some, and physician dispensing is certainly an issue for others in the pharmacy world, but neither is on the same level as compounds or opioids 10 years ago.

The level of importance that organizations place on pharmacy management and the grades they give their PBMs tend to correlate to the degree to which there are problems, with crisis times yielding high scores for pharmacy importance and low scores for their PBM.

Pharmacy importance scores have never been higher than at the height of the opioid crisis. In this year’s survey, pharmacy importance scores were near all-time lows.

Respondents are quite happy with their current PBMs, with most grading theirs as a 4 or 5 out of 5.

Opioid usage and spend decreased yet again, with overall spending on opioids decreasing roughly 8% and the percent of total pharmacy spend on opioids dropping to single digits for the first time in the survey’s history.

Pharmacy managers acknowledge that there are issues (like physician dispensing or TV drugs), but they believe these issues are largely manageable.

All of that should create an environment where pharmacy managers should be quite pleased, but few are. 

The lack of a clear, major problem has a majority of managers worried instead.

Respondents noted that they are the most uncomfortable when they don’t know what the problem is. Those who have been in the business long enough know that there is almost always a problem somewhere, and when it isn’t known, that means it is either brewing or worse: already present but not noticed yet.

What does this mean for you?

Enjoy the success, but stay vigilant.  

Jay Stith is the chief data analyst at Health Strategy Associates, a consulting firm focused on improving medical management programs in workers’ compensation. This column is republished with permission from the Managed Care Matters blog.