PBM - Medication Management Matters!

 

PBM - Medication Management Matters!

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In a realm where medication management holds the key to better healthcare outcomes, Pharmacy Benefit Management (PBM) takes center stage. Imagine a world where innovation and efficiency converge, creating a transformative framework that revolutionizes the way PBMs operate. Introducing Sonata, a pioneering Technology Partner poised to rewrite the rules of PBM management. With the industry rapidly evolving and the stakes higher than ever, Sonata's comprehensive solutions, expert guidance, and data-driven insights pave the way for unprecedented success.

Unlocking the secrets of cost-effective healthcare, Pharmacy Benefit Management (PBM) companies are the ingenious masterminds bridging insurers, pharmacies, and drug manufacturers. Through skilled negotiations and strategic alliances, PBMs secure lower drug costs, paving the way for savings and efficiency in the insurance industry and unlocking the key to affordable medications and a healthier future.

 

Revenue Streams of PBM

revenue

Reimagining PBM

The pharmacy benefit management (PBM) market size value in the United States is $518.6 billion in 2023, growing at a compound annual growth rate (CAGR) of 8.77% from 2022 to 2030. The PBM market is highly concentrated, with the top three players accounting for over 70% of the market share.

PBM Contracts

Traditional PBM Contract:

  • High rebates, low transparency
  • Hidden spread pricing is a cash cow
  • Client fees are not revealed
  • Conflicts of interest are possible

Pass-Through Contracts:

  • Fully transparent, client-centric
  • Pass-through rebates and savings rule
  • Customization is the mainstay

Pass-Through Contracts:

  • A blend of traditional and pass-through
  • Partial transparency equals partial savings
  • Clients receive part of the rebate pie
  • Incentives may be misaligned

PBM Escalators

  • Rising Prescription Drug Expenditure
  • Increasing Healthcare Expenditure
  • Growing Adoption of Generic Drugs
  • Technological Advancements
  • Increasing Demand for speciality medications
  • Focus on Patient-centric care
  • Legislative and Regulatory environment
  • Industry Consolidation and Partnerships

PBM Channels

  • Co-Payments
  • Co-insurance
  • Deductibles
  • Formularies Prior
  • authorization
  • Step Therapy
  • Utilization Management
  • Drug Utilization Review
  • Pharmacy Network Management
  • Claims Processing and Adjudication

PBM Enablers

  • Artificial Intelligence
  • Machine Learning
  • Data Analytics
  • Blockchain
  • Telehealth
  • Prescription Drug Benefit Management Software

Trends that are making the flow seamless

flow

Critical Business Factors of PBM

Transition

  • Data Migration
  • Training System
  • Integration
  • Change Management

Change benefits and Implementation

  • Identifying the Benefits
  • Planning the Change
  • Managing the Change

User Acceptance Testing

  • Defining clear objectives
  • Incomplete or Unrealistic requirements
  • Comprehensive testing coverage

How can Sonata help?

Sonata's transformative framework sets the stage for a new era of PBM management that enhances the legacy of modernization to the Next-Gen.

how-can-sonata-help
benefits

At the forefront, how does this benefit you?

  • Change Benefits Management
  • User Acceptance
  • Testing
  • Integration Capabilities
  • Workflow Optimization
  • Data Analytics
  • Technology solutions
  • Implementation Planning and Support
  • Continuous Evaluation and Improvement
benefits

If you are thinking about a Technology Partner, here is your checklist!

 

Understanding PBM Needs

 

Integration Capabilities

 

Reference and Client Success Story

 

Expertise and Experience

 

Scalability and Flexibility

 

Implementation Planning and Support

 

Comprehensive Technology Solutions

 

Partnership Approach

 

Continuous Evaluation and Improvement>

About Us

Sonata, As a pioneering Technology Partner, with exceptional expertise in change benefits management and User Acceptance Testing (UAT), offers transformative solutions for PBMs transitioning to new partners. By architecting meticulous implementation plans, providing continuous evaluation, and leveraging data-driven assessments, helping Payers and PBMs unlock successful technology integration journeys.