What They’re Watching: Anne Winter, Health Management Associates

Anne Winter, Principal at Health Management Associates in Phoenix, Arizona, joins us in this edition of “What They’re Watching” to discuss Pharmacy Benefit Managers and efforts to increase price transparency.

“So, I spend a lot of time thinking about PBMs. I came out of a PBM before I came to HMA. And, if there’s one thing everybody’s talking about, it’s price transparency. And, there are a lot of initiatives on how to do that. Like, you know: What is a rebate? Why do we have rebates? What’s the black box of PBMs?

And, I think there are a lot of really well-meaning initiatives going on. I just caution all the policymakers around pharmacy-pricing reform that it is such a complex supply chain that a fix over here might mean a break over here. It’s just really not one of those things, because of the complexity.

And so, I agree we need to figure out what to do about rising drug costs, and I think we just need a really thoughtful approach. And, while the Trump administration approach around point-of-sale rebates for members is, in theory, a great idea, I think there’s gonna be a lot of commentary on how that actually gets operationalized.

Every time I see one of these proposals, what I’m seeing is it really has a negative impact — not so much on the PBMs, which I think everybody thinks it’s gonna have an impact on, but really the pharmacies. And, I think that’s what people aren’t really realizing: That whenever you do something up here with drug pricing, and, you know, it really impacts the provider network, because that’s where they go to find savings. Like, if they lose margin over here, they’ve got to take the margin from somebody else.

And so, I think that’s one of the things that’s going to shake out, as these proposals get implemented or further discussed and vetted: is that, it’s the pharmacy community that’s really going to feel the brunt of these proposals, as opposed to the PBMs.

None of these proposals came out of the blue. These proposals came out of, probably, things that are already happening in the PBM industry, and I know several of– point-of-sale rebates is not new. Pricing transparency is not new. But, it may be new to certain parts of governmental pricing.

But, what I know about the PBM industry is they can pivot very quickly. This is not going to be something that is going to impact them dramatically, from an operational perspective. It might hit their margins a little bit, but they are very nimble, and they’ll be able to figure out how to fix that. Because they are such a nimble industry, I don’t see it impacting them as much as their provider network.”