True Transparency

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 35 years, 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.

While your pharmacy benefits may be passed through in your on-site pharmacies, you are missing significant savings if your PBM isn’t passing through actual costs from other retail pharmacies.

By leveraging your preferred acquisition strategy, you can benefit your health plan and your employees can pay the same submitted cost of a product as the PBM and an on-site pharmacy.

If you don’t have a true pass-through pricing plan, your health plan is paying more than the pharmacy is reimbursed for dispensed medication.

Self-insured health systems will be able to provide better healthcare at a lower cost within an ever-expanding coalition of members.

All rebates, dispensing fees, interest on rebates and discounts are passed through so that the only fee health systems pay is a management fee and a prior authorization fee.