Pharmacy Benefit Managers: Contracting Landscape and Manufacturer Competitive Positioning

Pharmacy Benefit Managers: Contracting Landscape and Manufacturer Competitive Positioning

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A carefully considered contracting strategy is critical to maintaining market access as pharmacy benefit managers (PBMs) work to keep costs low for members. HIRC's report, Pharmacy Benefit Managers: Contracting Landscape and Manufacturer Competitive Positioning, reviews PBM key decision makers' evaluation of manufacturers and focuses on trends in contracting. The report addresses the following questions:

  • Which manufacturers lead in PBM executives' evaluation of willingness to contract?
  • Which contract types are most commonly offered for traditional, specialty, and oncology medications? Which are the most preferred?
  • How are PBM excluded product lists evolving for traditional, specialty, and oncology medications?
  • What is the estimated level of rebates manufacturers are willing to offer to gain access across 12 therapeutic classes?
  • How is the availability of risk/outcomes-based contracts evolving?

Key Finding: Flat access rebates tied to preferred position are most commonly offered by manufacturers and are most favored by PBM customers.

AstraZeneca and Novo Nordisk are Rated Highest by PBMs in Willingness to Contract. Respondents were asked to consider and rate 41 very large, large, and mid-size pharmaceutical firms on their overall willingness to contract. Pharmacy benefit manager executives rate AstraZeneca highest in willingness to contract on average, followed by Novo Nordisk. Top firms are noted for diverse product portfolios, incentive offerings, flexibility in negotiations, and overall ease of the contracting process.

Flat Access Rebates Tied to Preferred Position is PBMs' Most Preferred Contract Type. When asked to select one of seven contract types as most preferred, 55% of pharmacy benefit manager respondents chose flat access rebates tied to preferred position. An in-depth analysis of factors driving nominations reveal that flat access rebates tied to preferred position are preferred due to ease of administration, low operational investment, and because they allow for maximum savings.

Research Methodology and Report Availability. In December 2016 and January 2017, HIRC surveyed 25 pharmacy benefit manager key decision makers from stand alone, health plan-owned, and retail-owned PBMs. Online surveys and follow-up telephone interviews were used to gather information. The complete report, Pharmacy Benefit Managers: Contracting Landscape and Manufacturer Competitive Positioning, is available now to HIRC’s Managed Markets subscribers at www.hirc.com.

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