PPO Pharmacy Benefits Survey

Managerial Results for 2007 – Just Released

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[By Staff Writers]

  • In 2006, the average number of eligible employees in PPOs that used managed care pharmacy programs was 203,768, up 7.2% from 190,097 the previous year.
  • For the sixth straight year, the share of PPOs that used PBMs for drug utilization review (DUR) services fell, to 62.7% from 66.1% in 2005.
  • The percentage of reporting PPOs that followed drug formularies increased fractionally in 2006, to 98.6% from 98.3% the year before, the sixth consecutive annual rise.
  • For the fifth consecutive year, the percentage of reporting PPOs that contracted with mail-service pharmacies grew, to 98.9% in 2006 from 98.3% in 2005.
  • Between 2005 and 2006, the overall share of PPO prescriptions filled with brand name drugs fell modestly, to 53.8% from 55.4% the previous year.
  • The average number of contracts between PPOs and hospitals jumped 18.9% in 2006, to 145 from 122 the year before.
  • The percentage of PPOs using a pharmacy benefit manager (PBM) was 99.2% in 2006, up slightly from 98.6% the year before, and the highest such share since this Digest began tracking this measure.
  • In 2006, PPOs contracted with an average of 38.9 ancillary providers per 1,000 eligible employees, up 28.4% from 30.3 the previous year, and the highest such number since 2002 (41.4).
  • At PPOs with at least 1 million eligible employees, the average number of hospital contracts per plan climbed a notable 14.2%, to 1,804 from 1,579 in 2005.


The editors acknowledge Verispan LLC, Yardley, Pa., as the research and reporting source for this data, reprinted with permission and based on information gathered by mail and telephone surveys gathered and effective as of December 31, 2008, unless otherwise noted.  It was commissioned, sponsored and underwritten in an arm’s length fashion by the Managed Care Digest Series of sanofi-aventis, Bridgewater, NJ, and developed and produced by Forte Information Resources, LLC, Denver, Colorado.


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6 Responses

  1. Some drug firms are raising prices in the face of health reform. Critics say that the industry aims to set a higher drug price base before new legislation passes.


    What do you say?


  2. Health Advocacy Groups Take Drug Company Cash

    An analysis of health advocacy groups listed in a drug company’s donation registry has found that a vast majority of the non-profit organizations did not disclose their corporate funding source.




  3. Employer-Reported Understanding of Specialty Pharmacy Benefits

    Very Little 4%
    Average 37%
    Above Average 49%
    High 10%

    Source: Managed Care, September 2013


  4. On PBMs

    To get around pharmacy gag rules, ask about drug costs.


    Dr. David E. Marcinko MBA

    Liked by 1 person

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