News & Updates

WhitePaper: PBM Impact on Employers & Risk to Health Systems

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.

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Catetories: WhitePaper

The Healthcare Cost Crisis and Impact of Traditional PBM

The Problem

America is facing a crisis with rising health care costs, especially when it comes to the costs of prescription drugs. Drug costs are skyrocketing—especially generic drugs whose costs logically could be expected to remain flat or even decrease.

Although many factors contribute to rising health care costs, attention is beginning to focus on the largely hidden role played by pharmacy benefit managers (PBMs). Over the last three and a half decades, PBMs have expanded their behind-the-scenes role as claims administrators to become power players in a trillion-dollar industry. As prescription drug costs have risen, PBM earnings have greatly outpaced health insurers, retail pharmacies and pharmaceutical wholesalers.

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Catetories: WhitePaper, Healthcare