Recent healthcare headlines send a clear message that even some of the largest health plans are having difficulty managing their pharmacy benefits: Read more about Anthem’s lawsuit against Express Scripts.

Insurer alleges pharmacy-benefit manager violated contract, seeks $15 billion in damages. “The insurer said it believes the gap between current pricing and what it believes to be appropriate is about $13 billion over the rest of its contract, plus $1.8 billion covering a post-termination wind-down period.” Wall Street Journal, March 22, 2016.

Since that time Express Scripts has countersued Anthem in this contract dispute and has denied claims that it refused to negotiate pricing terms. TPG-HC will monitor these lawsuits as the outcome may have a tremendous impact on drug pricing and contracting.

If larger plans are experiencing significant challenges, how are smaller health plans and employers expected to do a better job of managing pharmacy benefits, working with fewer resources and less purchasing power? Stay tuned for updates and commentary from TPG-HC team on pharmacy benefit management best practices. (Note – do we have a piece of content on pharmacy benefit management best practices we can point to? would be a good content link …if not we can leave without but here’s opportunity to show our expertise in the area).
Click here to learn more about TPG-HC’s Pharmacy Benefit Management solutions – whether your goal is PBM cost savings, modernization or growth, TPG-HC is the business partner who can guide you there.