Impact on self-insured employers
In a 2017 survey by the National Pharmaceutical Council, 63 percent of corporate executives believed that PBMs lacked transparency about how they made money. Without full transparency, prescription pricing is so complex that it’s virtually impossible for even the best-informed plan sponsor to understand the relationship between PBM fees and actual drug costs. In addition, 58 percent of respondents believed that contracts were too complex, ambiguously worded and often benefitted PBMs at the expense of employers. Perhaps most telling, only a third of employers said their PBMs were “strongly aligned with their own goals for managing employee health, productivity and costs.” In the same NPC survey, only 30 percent of corporate executives said they had a complete understanding of their PBM contracts. Faced with the complexity of prescription benefits, self-insured employers often turn to consultants, health plans and the “Big Three” PBMs themselves for recommendations on plan design.