The role of pharmacy benefit managers in integrated care

Perspective: Connected care | Capability: Pharmacy | By: Carelon

Integrated care is a pivotal focus of healthcare organizations and providers aiming to address the diverse needs of patients. In pharmacy, care teams and pharmacy benefits managers (PBMs) navigate daily challenges to ensure personalized and empathetic support for patients, connecting the dots between medical, pharmacy, and behavioral health care.

In the following interview, CarelonRx President Paul Marchetti shares his perspective on the role PBMs play in healthcare.


How do PBMs make a difference?


PBMs are absolutely critical to accessibility, health equity, and outcomes. First, they are the only entity in the supply chain that's focused on lowering costs, making medications more affordable for the patients who need them.

Additionally, nearly four billion prescriptions  are filled in the U.S every year. And each year, the FDA receives more than 100,000 reports  associated with preventable medication errors. Within the next decade, PBMs are projected to help prevent 1 billion medication errors . That means fewer strokes and fewer heart attacks through better medication management and clinician engagement.


What’s another way that PBMs can support better outcomes?


As an example, for diabetes patients alone, PBMs and the pharmacists within them help improve drug therapy and adherence to prevent incidents of heart attacks, stroke, and kidney disease. Through specialty pharmacy services, PBMs also help to extend and improve upon the quality of life for patients battling complex conditions such as multiple sclerosis and rheumatoid arthritis.


Providers, of course, are critical in managing medications for their patients. How do PBMs support them?


Driving connectivity within the delivery system is also very important for PBMs, and CarelonRx specifically. By connecting with physicians and hospitals and providing them with insights on their patient population, we make sure they receive information on gaps in care and patients that are not adherent to their medications in real time. They then can reach out to engage patients to close those gaps.


How do PBMs reduce healthcare complexity? And what is CarelonRx doing specifically to promote better-connected experiences?


We all know that the healthcare environment is growing increasingly complex. That complexity is driven by factors like an aging population and an increase in chronic, comorbid conditions. So, the need for more connected and integrated care is becoming more and more important.

At CarelonRx, we've taken the next step by integrating medical, behavioral, and pharmacy benefits, using holistic clinical insights, and collaborating with a patient's care team to address the many challenges they face. This allows us to connect patients with the right medicine, at the right time, at the right price — translating to higher quality outcomes. That's what sets us apart.


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