Course
Pharmacy Spend in Value-Based Contracts
The fastest-growing line in total cost of care and the one providers control least: the medical and pharmacy benefit split, the concentrated supply chain the FTC documented, what drug spending actually sits inside a benchmark, the levers that work, and the policy changes reshaping all of it.
By the end of this course, you will be able to:
- Distinguish medical benefit from pharmacy benefit spending and explain why the split matters
- Determine which drug spending sits inside a given benchmark and whether it is measured gross or net
- Separate the drug costs an organization can influence from those it can only finance
- Apply formulary, site of care, substitution, and adherence levers without creating barriers to indicated care
- Explain how the Part D redesign, price negotiation, and GLP-1 affordability are reshaping the field
How Drug Spend Flows
Two benefits, one patient, and a supply chain in which six companies manage nearly 95 percent of American prescriptions while owning the pharmacies that dispense them.
Drug Spend Under Total Cost Accountability
Medicare's largest ACO program excludes Part D entirely. What is inside your benchmark, how to finance specialty exposure, and why adherence runs opposite to everything else.
Managing Drug Spend in Practice
Formulary and utilization tools and where they become barriers, the two levers that change price without changing therapy, and why nearly every published figure is the wrong number.
Drug Spend Across Payers
GLP-1s as the affordability stress test, the federal model built to answer it and already half delayed, and why the same drug reaches three payers at three different prices.
The Policy Layer
The Part D redesign moved catastrophic risk onto plans, Medicare began negotiating prices directly, and a closing assessment of what a risk-bearing organization can actually do.