Employer Pharmacy Benefit Management Guide

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National Alliance Releases Employer Pharmacy Benefit Management Guide to Drive Transparency and Quality

Resource features assessments of Cigna, CVS Caremark, Express Scripts,
MaxorPlus and Navitus Health Solutions

 

WASHINGTON – December 16, 2020 – To arm employers and other purchasers with critical data on the performance of their pharmacy benefit management (PBM) vendors, the National Alliance of Healthcare Purchaser Coalitions released its annual assessment. This year’s evaluation reviews five PBMs, representing over 70 million covered lives: Cigna, CVS Caremark, Express Scripts, MaxorPlus and Navitus Health Solutions.

“Pharmacy benefit management transparency is critical if we are to move the market to better performance and value, and this report is a step forward in making that a reality,” said Michael Thompson, National Alliance president and CEO.

New this year, the PBM assessment comparison is public whereas this information was previously only available to National Alliance coalition members.

“Most of the information available to employers about the best practices in pharmacy benefit management come from the PBMs themselves,” said Janet McNichol, human resources director, American Speech-Language-Hearing Association. “This assessment is an important source of information offering third-party credibility and is the most valuable tool I’ve found to educate myself about the factors to consider in selecting a PBM partner.”

The following categories were measured in the assessment:

  • Business practices including level of transparency. The top performing PBM, Navitus, showed the greatest transparency into pharmacy network, pharmaceutical industry, and site of care contracts. The top two performing PBMs for specialty pharmaceutical management which includes measures such as access criteria, utilization strategies, and patient safety and adherence were Cigna and Navitus.
  • Cigna and MaxorPlus were the highest scoring PBMs in chronic disease and behavioral health management, which examined adherence monitoring and coverage of behavioral health/substance use medications, and monitoring for appropriate prescribing among clinicians.
  • The efficiency and appropriateness of care module assessed the types of strategies PBMs use to assure appropriate, cost-effective utilization, including managing the overuse of antibiotics of concern. An emphasis is placed on removing low-value medications from the formulary, where Navitus, MaxorPlus and Cigna all compared favorably.
  • The PBMs generally met the standard of URAC Accreditation, including mail order and specialty pharmacy, but only CVS Caremark achieved URAC’s accreditation for Drug Therapy Management.
  • Purchasers are emphasizing not only drug price, but value. As an example, Express Scripts reported on their oncology program that aligns a drug’s cost with its health outcomes for specific types of cancer.

“This resource provides coalitions and employers with critical data on the performance and other industry comparisons of PBMs,” said John Miller, executive director, MidAtlantic Business Group on Health. “Key insights such as understanding what biosimilar substitutions are made as part of the specialty drug mix or policies related to low-value drugs enables purchasers to better manage the performance of their vendors and offers key data for future vendor selection.”

The PBM report is available here.

About National Alliance of Healthcare Purchaser Coalitions

The National Alliance of Healthcare Purchaser Coalitions (National Alliance) is the only nonprofit, purchaser-led organization with a national and regional structure dedicated to driving health and healthcare value across the country. Its members represent private and public sector, nonprofit, and Taft-Hartley organizations, and more than 45 million Americans, spending over $300 billion annually on healthcare. To learn more, visit nationalalliancehealth.org and connect with us on Twitter and LinkedIn.

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Media contact:
Cary Conway
cconway@nationalalliancehealth.org
972.649.4707