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Raulo S. Frear, PharmD, Says How PBMs Are Aligning Benefit Designs for Delivery System Reform

Published on: February 26, 2014

Conference | Managed Markets Summit

Raulo S. Frear, PharmD, general manager, OmedaRx, says pharmacy benefit managers are aligning benefit designs for delivery system reform in a few ways. With respect to the delivery system reform, if you look at ACOs as a specific example, our experience has been that the ACOs are not really ready to talk about different benefit designs, Dr Frear says. They're still learning what it means to accept risk and that means risk across a lot more areas than just pharmaceuticals.

Raulo S. Frear, PharmD, general manager, OmedaRx, says pharmacy benefit managers are aligning benefit designs for delivery system reform in a few ways.

“With respect to the delivery system reform, if you look at ACOs as a specific example, our experience has been that the ACOs are not really ready to talk about different benefit designs,” Dr Frear says. “They’re still learning what it means to accept risk and that means risk across a lot more areas than just pharmaceuticals.”

He adds that over time, as various programs are put into place, and as evidence of these programs affecting cost emerge, reform will naturally lead to different types of designs in benefits, formulary, or utilization management tools.