PBMs Help Improve Medicaid Outcomes with Pharmacy-Centered Care Programs
Pharmacy benefit manager (PBM) partnerships with independent community pharmacies led to measurable improvements in Medicaid members’ health outcomes. Members engaged in CarelonRx’s Community Pharmacy Total Care (CPTC) program in eight states experienced increased medication adherence and improved quality outcomes across multiple chronic conditions.
Elevance Health’s PBM CarelonRx established the CPTC program to identify Medicaid members with complex needs who would benefit most from personalized care and connect them with independent community pharmacies to receive enhanced services. Pharmacists simplify participating members’ treatment regimens by offering medication synchronization, custom prescription packaging, scheduled hand-delivery, regular consultations, and personalized care plan development. The CPTC program offers a variety of supports to pharmacists to help them address participants’ needs.
This analysis found that participants in the CPTC program in multiple states took their medications more consistently and experienced fewer gaps in care with respect to several of the most common chronic conditions among Medicaid members, including cardiovascular disease and diabetes.
Related Public Policy Research
Outcomes in Medicaid Members Engaged in Health Plan, PBM, and Community Pharmacy Collaboration
Results from a value-based collaboration between a health plan, pharmacy benefit manager, and independent community pharmacies demonstrate these arrangements can improve outcomes for Medicaid members with higher healthcare needs.
PBM and Community Pharmacy Partnerships Can Improve Medicaid Outcomes
Individuals’ visits to community pharmacies outnumber visits to other healthcare provider types by nearly 2:1. Value-based care arrangements between pharmacy benefit managers (PBMs) and independent community pharmacies, where enhanced services are performed, can improve outcomes for individuals at higher risk for poor health outcomes.
There is a growing understanding of the clinical roles that pharmacies and pharmacists can play, beyond medication dispensing and adherence, such as medication adjustment, vaccination, and outcomes monitoring. Value-based payment (VBP) in pharmacy has the potential to recognize the contributions pharmacies and pharmacists can offer to improve patient outcomes and reduce costs.
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