Why one health system thinks its new PBM can disrupt the market

Why one health system thinks its new PBM can disrupt the market
Modern Healthcare; by Lauren Berryman; 8/23/24
The University of North Carolina-affiliated health system announced a plan this month to launch UNC Health Pharmacy Solutions, a "transparent" PBM for employers seeking an alternative to CVS Health subsidiary CVS Caremark, Cigna division Express Scripts and UnitedHealth Group unit OptumRx, which dominate the market... “Our costs were skyrocketing,” DeFalco said. UNC Health has since in-sourced key PBM functions and customized its formulary to focus on lower net cost drugs. UNC Health Pharmacy Solutions is similar to others that market themselves as transparent. UNC Health will charge clients administrative fees and pass through all rebates to plan sponsors. The health system has saved 32% on employee pharmacy costs and expects to deliver similar results to employers in North Carolina and South Carolina, DeFalco said. The health system may consider partnering with businesses in bordering states down the line, she said... The landscape comprises around 70 players, but CVS Caremark, Express Scripts and OptumRx have a combined market share of about 80%, and the top six PBMs control 90%. Larger PBMs generally can use scale to extract better rebates from drugmakers, which at face value could look attractive to benefits brokers even though it may not mean lower overall savings.