What is a Group Purchasing Organization Relevance to a PBM ?

Posted on: February 28, 2024

Group Purchasing Organizations (GPOs) play a significant role in the healthcare industry by leveraging the collective purchasing power of their members to negotiate discounted prices and favorable terms for medical supplies, pharmaceuticals, and other healthcare products and services.

Group Purchasing Organization Relevance to a PBM

While GPOs primarily focus on negotiating contracts for medical supplies and equipment, they can also influence pharmacy benefit management (PBM) services in several ways:

1. Negotiating pharmacy contracts:

Volume Discounts: GPOs negotiate Contracts with PBMs on behalf of their member organizations to secure volume discounts, rebates, and favorable pricing terms for prescription medications and pharmacy services.

Formulary Placement: GPOs may advocate for the preferred formulary placement of certain medications within PBM networks, influencing drug coverage and utilization patterns among member organizations.

2. Formulary Management:

Formulary Development: GPOs collaborate with PBMs to develop and manage formularies that optimize medication access, affordability, and clinical outcomes for member organizations.

Therapeutic Interchange Programs: GPOs may implement therapeutic interchange programs that encourage the use of cost-effective or preferred medications within member organizations’ formularies, promoting cost savings and medication safety.

3. Clinical Support and Education:

Clinical Guidance: GPOs provide member organizations with clinical support, evidence-based guidelines, and educational resources to promote rational medication use, adherence to formulary protocols, and adherence to best practices in pharmacy management.

Drug Utilization Review (DUR): GPOs may conduct drug utilization reviews and analysis to identify opportunities for optimizing medication therapy, reducing medication errors, and minimizing adverse drug reactions.

4. Benchmarking and performance monitoring:

Benchmarking Data: GPOs collect and analyze benchmarking data on pharmacy utilization, cost trends, and quality metrics to help member organizations benchmark their performance, identify areas for improvement, and make informed decisions about pharmacy benefit design and management.

Performance Monitoring: GPOs monitor PBMs’ performance, contract compliance, and adherence to service level agreements to ensure that member organizations receive the intended benefits and value from their pharmacy contracts.

5. Advocacy and Representation:

Policy Advocacy: GPOs advocate for policy changes, regulatory reforms, and industry initiatives that promote transparency, accountability, and fairness in pharmacy benefit management practices.

Stakeholder Engagement: GPOs engage with PBMs, pharmaceutical manufacturers, regulatory agencies, and other stakeholders to address emerging challenges, promote innovation, and advance shared goals related to medication access, affordability, and patient care.

Conclusion:

Group purchasing organizations (GPOs) collaborate with pharmacy benefit managers (PBMs) to negotiate pharmacy contracts, manage formularies, provide clinical support and education, benchmark performance, and advocate for policy reforms. By leveraging their collective purchasing power and expertise, GPOs play a vital role in optimizing pharmacy benefit management services and enhancing value for their member organizations in the healthcare supply chain.