The Impact of Medicare Part D on Pharmacy Benefit Managers
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1 The Impact of Medicare Part D on Pharmacy Benefit Managers Actuaries Club of the Southwest and Southeastern Actuaries Conference Joint Annual Meeting November 17, 2006 Troy M. Filipek, FSA, MAAA Actuary Tel:
2 Agenda Introduction to PBMs PBMs under Part D Roles Benefits Challenges How can actuaries help? 11/17/06 M I L L I M A N 2
3 PBMs The Basics PBMs serve as intermediaries between pharmaceutical manufacturers, pharmacies, and various pharmaceutical purchasers (employers, health plans, etc.) PBM goals and objectives Manage drug spend appropriately Improve health outcomes Facilitate efficient administration of pharmacy benefits Growth and profitability 11/17/06 M I L L I M A N 3
4 PBMs The Basics (continued) How do PBMs achieve these objectives? Volume discounts bring size to the table Plan design / formulary management Align incentives to manage costs Monitor drugs in the pipeline Alternative revenue sources Mail order pharmacies Sales of data 11/17/06 M I L L I M A N 4
5 PBMs The Basics (continued) How do PBMs achieve these objectives? (continued) Drug management programs Influence physician prescribing and pharmacist dispensing behaviors Identify potentially adverse drug interactions Balance drug efficacy and cost Identify low cost substitution opportunities 11/17/06 M I L L I M A N 5
6 The Impact of Medicare Part D Medicare Modernization Act of 2003 (MMA) introduced prescription drugs as a new benefit under Medicare Offerings provided entirely by the private sector no traditional FFS as with medical Unique benefit, large variety of offerings, and high government subsidies have led to major media and political scrutiny of Part D 11/17/06 M I L L I M A N 6
7 The Impact of Medicare Part D (continued) Winners Medicare eligible beneficiaries Health plans Pharmaceutical companies Pharmacies Employers PBMs Losers Taxpayers Budget hawks Opponents of private market reforms 11/17/06 M I L L I M A N 7
8 PBM Roles Under Part D Become a PDP Three largest PBMs have all gone this route (Medco, Express Scripts, Caremark) Accepting risk - new concept for some, nightmare from years past for others Competing with existing health plan clients Assist employer clients Employers have options under Part D Retiree Drug Subsidy (Continue primary coverage) Secondary Wrap Plan Employer Group Waiver Plan Drop Coverage 11/17/06 M I L L I M A N 8
9 PBM Roles Under Part D (continued) Continue intermediary role Larger increase in the insured population More dollars at stake Average 2006 <65 Drug Spend = about $700 - $800 Average 2006 >65 Drug Spend = about $2,400 - $2,700 Leverage current relationships on commercial side More volume = better discounts / rebates / dispensing fees 11/17/06 M I L L I M A N 9
10 PBM Benefits Under Part D Expanded Medicare population to serve 2005: 24.3 million with comprehensive coverage (59%) 2006: 38.2 million (90%+) Previously unmanaged population = Big Opportunity Business diversification opportunity Ability to demonstrate expertise and willingness to help in confusing program Enhanced bargaining power 11/17/06 M I L L I M A N 10
11 PBM Challenges Under Part D Increased scrutiny Contract transparency emphasized buyers becoming more savvy Newly introduced accreditation programs CMS oversight Enhanced competition Smaller PBMs Health plan owned PBMs Enhanced competition 11/17/06 M I L L I M A N 11
12 PBM Challenges Under Part D (continued) Difficult population to manage Managing specialty drugs Additional legal risk Increased administrative requirements (CMS reporting) Competing with existing customers CMS timetables same for all clients 11/17/06 M I L L I M A N 12
13 How Can Actuaries Help? Health plans / employers Independence PBMs not required to act as fiduciary to clients Dispel PBM myths Generic or mail use always good Can evaluate PBMs by looking solely at discounts, rebates and administration Transparent contracts are always best 11/17/06 M I L L I M A N 13
14 How Can Actuaries Help? (continued) Health plans / employers (continued) Tasks Plan design / formulary analysis Benchmarking PBM contract assessment / selection Review of drug management programs 11/17/06 M I L L I M A N 14
15 How Can Actuaries Help? (continued) PBMs Understand insurance risk under Part D Lack underwriting expertise Build / support insurance operation infrastructure Quantification tools Great data going to waste Current tools lack quantitative rigor Understand insurer / employer viewpoint We know their clients well! What are they seeking / demanding 11/17/06 M I L L I M A N 15
16 How Can Actuaries Help? (continued) PBMs (continued) Tasks Medicare Part D option comparison for employer clients Pricing and managing insurance blocks Other Part D assistance Illustrate new ways to provide value Assist with regulatory issues requiring an actuary 11/17/06 M I L L I M A N 16
17 Summary PBMs fill a unique intermediary role in providing prescription drugs to beneficiaries that can help all parties involved PBMs gain significantly from Medicare Part D, but also face challenges that are heightened under the new program We can help on both sides of the table! Questions??? 11/17/06 M I L L I M A N 17
18 Contact Information Troy M. Filipek, FSA, MAAA Actuary Milliman, Inc Bluemound Road, Suite 400 Brookfield, WI /17/06 M I L L I M A N 18
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