After the failure of the drug company/PBM mergers of the mid-1990s, the notion that pharmacy benefit managers can play a strategic role in drug selection finds few takers among drug company executives who, instead, now embrace a status quo ante bellum view that new, innovative products and strong brands succeed or fail without the influence of PBMs. But several recent trends, including a significant industry consolidation, have left a core group of market leaders bigger and more focused than ever. In particular, the growing influence of the Internet as both a tool and information source and the likely passage of Medicare drug coverage should make PBMs more influential in product selection and formulary management. Behind both lies a newly empowered consumer, a force that has bedeviled PBMs in the past but which they now seek to embrace. Express Scripts officials argue that their focus on traditional PBM values should, if anything, make them more, not less relevant to drug companies in the future.

A. T. Kearney consultants suggest ways for pharmaceutical companies to increase shareholder value.

Just over a year ago, the acquisition of managed care specialist ValueHealth by hospital giant Columbia/HCA seemed a match made in heaven--and a new way of thinking about the way to put pharmacy benefit management in context after the failed drug company acquisitions of 1993-4. Now Columbia is spinning ValueRx off. The new deal makes Express Scripts the largest independent PBM in the country and both solidifies and diversifies its customer base. But it also likely spells the end to the PBM alliances of the past several years.

Service & Device to ensure patient compliance. PolyPharm's {MedManager} service links patients, physicians and payers with a patented hand-held pill dispensing device which alerts and instructs patients and also collects physiological data which can bedownloaded daily to medical personnel.