Meet the Board: Perry Cohen of The Pharmacy Group Talks Current PBM Status

Perry Cohen, Pharm. D, CEO of The Pharmacy Group, has worked in managed healthcare for 40 years with many health plans. Cohen says he is extremely familiar with pharmacy benefit management (PBM) and in 2021, "pharmacy has never been crazier or hot. It's out of control."

Q: So, Perry, what would you say is hotter and wilder than ever? What is going crazy in the pharmaceutical sector?

A: There are pharmaceutical companies, and there are patients, drug companies make drugs to help patients get better and treat disease. And that's the world as we know it, between drug companies and patients are all this infrastructure physicians who prescribe pharmacies who dispense wholesalers who move things around. And that's just the delivery of health care.

Then on top of that, you talk about financing. So on the delivery side, and distribution at the retail pharmacy level, there's something called Amazon out there being disruptive. (There are) a lot of those dynamics are happening. And from a wall street perspective, it's simple. But these companies have bit off more than they can chew in a lot of ways and never digested properly.

And you start to start to see ways of consolidation and fragmentation and consolidation and fragmentation. So for example, just as the pharmacy benefit industry has major players: CVS, Aetna, Express Scripts, Cigna and OptumRx; there's a whole new generation of PBMs that are being launched. All these startups that are really technology companies that are managing the pharmacy benefit. At the same time health plans are going through the exact same change. I'm a health plan guy. I've been doing health plans for 40 years, but if you talk to the people at Oscar or Clover Health insurance, they've got a whole different model where they're technology first, consumer second. And we'll fill in with the pieces, which you know: adding a hospital, adding a doctor, whatever.

And then there's digital pharmacies out there where you can see ads on TV where you can buy erectile drugs or whatever, and just click this and go to your website and order stuff. So for the consumer, there's a lot of ways to access healthcare now digitally and in person. And then COVID-19 just accelerated the movement of that for some people.

The last issue is financing of healthcare: government, Medicare, Medicaid, commercial, employer base, and then the individual market, regardless of who's the president, and whether it's red or blue. Technology is changing healthcare. And the thing you have to remember is healthcare is an information business first, and I'm a pharmacist, and I'm like, wait, it's a patient care business? No, it's information. And all the information is available digitally now. So all these things are kind of coming together.

Because we're talking about health care and physicians, we're seeing a generational change in physicians and health care. If you talk to any physician, just ask him how old they are. If they're over the age of 60, they want to get out. If they're under the age of 40, they're following fine. Those physicians between ages 40 and 60, regardless of their practice, or their specialty, are very frustrated, or angry. And so when your doctors aren't happy, healthcare is not going to work, right. And a lot of us tend to move around them.