Pharmacy Benefit Resources

The National Alliance of Healthcare Purchaser Coalitions is addressing a number of topics affecting the pharmacy and medical side of benefits including contracting and formulary management, reducing waste, pharmacy benefit manager (PBM) performance, pricing inequity, personalized medicine, and value-based benefit design. This website provides background on the initiative as well as additional related resources to pharmacy benefit management.

The National Alliance's 2020 Findings on the State of the PBM Industry report includes a sample of Pharmacy Benefit Managers (PBM), with large and small, “carve-out” and “carve-in” organizations demonstrating their commitment to transparency by answering questions on their policies and programs.

The National Alliance Medical Directory Advisory Council put together a framework to educate and advise employers on prescription drug value.

The Midwest Business Group on Health developed a report titled Precision Medicine in Pharmacy Design:Pharmacogenomics & Pharmacogenetics to help benefit leaders and consultants understand how individual’s genes affect their response to medications and how they are used within the pharmacy benefit for self-insured employers. The article also provides clinical and administrative guidance and action steps employers can take to best utilize Pharmacogenomic (PGx) testing.

The Midwest Business Group on Health and Mid-America Coalition on Health Care put together Considering Authorized Generics in Pharmacy Benefits Design, a resource designed to examine authorized generics (AG), how they can impact the marketplace and also provide guidance to employers so that AGs are covered under the pharmacy benefit.

The Pharmacy Benefit Management Institute (PBMI) put together a resource evaluating the unintended consequences of step therapy and prior authorization when it comes to utilization management.

The PBMI developed a resource guiding employers to look further into a proactive utilization management policy discussion. This resource outlines various considerations that employers should take into account when developing programs.