AH010 - The Power of PMPM: Holding PBMs Accountable for Total Drug Spend, with Kristin Begley, PharmD

Per member per month (PMPM) cost plays a crucial role in healthcare, particularly in pharmacy benefit management. On this episode of the Astonishing Healthcare Podcast, Kristen Begley, PharmD, Chief Commercial Officer at Capital Rx, emphasizes the significance of PMPM guarantees and how they help hold pharmacy benefit managers (PBMs) accountable for total drug spend. The PMPM calculation provides a simplified way to evaluate drug spend by dividing the total plan spend by the number of members. This enables plan sponsors and other industry professionals to easily assess the value and effectiveness of their vendors and predict future costs. Furthermore, PMPM guarantees prompt PBMs to act in the best interest of both the plan sponsor and the members, ensuring the selection of the most appropriate, cost-effective drugs, for example. Drug mix, formulary decisions, prior authorizations, and clinical programs also strongly influence PMPM and should be carefully considered. Last, Kristin shares the most astonishing thing she's seen, and it's amazing how costly the things people can miss are. Related PMPM Content PMPM - Is It the Best Way to Measure or Track Anything? PBM Procurement: A PMPM Guide for Plans Sponsors eBook   Visit Capital Rx Insights for this episode's transcript and additional content!