Integrating dynamic pricing models with pharmacy benefit manager strategies to enhance medication affordability and patient adherence

Jagun, Tolulope O and Mbanugo, Olu James and Jimoh, Olusegun (2025) Integrating dynamic pricing models with pharmacy benefit manager strategies to enhance medication affordability and patient adherence. World Journal of Advanced Research and Reviews, 25 (3). pp. 171-187. ISSN 2581-9615

Rising prescription drug costs present a significant barrier to medication adherence and healthcare affordability, requiring innovative pricing strategies to balance cost control, patient access, and pharmacy benefit manager (PBM) collaboration. Traditional fixed pricing models often fail to adapt to patient-specific financial constraints and fluctuating market dynamics, leading to increased non-adherence rates and financial inefficiencies. The integration of dynamic pricing models with PBM strategies offers a scalable solution to enhance medication affordability while ensuring sustainable reimbursement structures for stakeholders. This study explores the implementation of value-based pricing, tiered copay structures, and AI-driven predictive analytics in optimizing medication pricing, formulary placement, and PBM negotiations. By leveraging real-time data analytics, dynamic pricing models can adjust medication costs based on patient income levels, prescription adherence trends, and competitive market fluctuations. Additionally, AI-enhanced PBM strategies facilitate risk-based contracting, rebate optimization, and targeted cost-sharing mechanisms, reducing out-of-pocket expenses for high-risk patient populations. Through case study analysis, this research examines successful integrations of AI-driven pricing models with PBM frameworks, demonstrating their impact on cost reduction, improved medication adherence rates, and enhanced formulary management. It also addresses potential challenges, including regulatory compliance, data privacy concerns, and equitable access to discounted pricing structures. By aligning dynamic pricing strategies with PBM-driven cost optimization techniques, healthcare systems can achieve greater affordability, improved medication adherence, and a financially sustainable pharmaceutical ecosystem that benefits patients, insurers, and providers alike.