Pharmacy Management

Pharmacy management is moving further into the core of value-based care as payers and providers tie medication access, adherence, and specialty-drug coordination to avoidable utilization: a Humana analysis found pharmacy care coordination for cancer patients was associated with lower costs and fewer hospitalizations, reinforcing the strategic case for embedding pharmacists in oncology, CKD, and other high-cost care models (Humana study). At the same time, CMS under the Trump administration is advancing scrutiny of Medicare Part D pharmacy contracting standards and PBM practices, creating pressure on plan sponsors, PBMs, specialty pharmacies, and ACO-aligned provider groups to rethink network terms, data-sharing, and benefit designs that can either enable or undermine longitudinal medication management (CMS RFI reaction). The strategic tension for VBC leaders is that pharmacy is increasingly a population-health lever, but opaque PBM economics, fragmented medical/pharmacy benefit data, and specialty pharmacy payment gaps still limit accountability for total cost of care and outcomes.