Prescription Drugs - Medicine & Money

The truth about prescription drug costs.

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Employers

• Employers and PBMs
• 10 Questions You Should Be Asking
• Back to the Future for PBMs
• Mail Order Myth
• True Transparency
• PBMs Drive Up Drug Prices
• Yet Another Consultant
• Big Business Clout

 

Employers, sponsors and health plans are invited to participate in a study examining their prescription drug plan expenditures conducted by the University of Texas College of Pharmacy Center for Pharmacoeoconomics Studies. Contact Center Director Marvin Shepherd, Ph.D.

Employers and Pharmacy Benefit Managers

Conscientious employers have an obligation to provide quality, cost-effective health insurance. It’s with good intent that employers contract with pharmacy benefit managers to get the best prices possible for the medications their employees need. But there are problems.

• Pharmacy benefit managers make money from both sides: from employers and from pharmaceutical manufacturers. The deals between drug companies and pharmacy benefit managers actually result in higher drug prices, even when it costs employers and employees more, because pharmacy benefit managers act in their own best interest rather than their clients’ in obtaining paybacks from the drug companies. Pharmacy benefit manager experts point out there is no accreditation standard for PMBs, and suggest the need for an accreditation program.
• Pharmacy benefit managers receive paybacks from pharmaceutical manufacturers to promote that manufacturer's drugs. As a result, patients/employees may be forced to use a brand name when a generic is readily available, costing both the employer and the patient/employee more.
• Employers save money for themselves and their employees if they are careful selecting a pharmacy benefit manager and demanding full accountability at all levels of the contract. The National Community Pharmacists Association offers 10 Questions Employers Should Ask Their Pharmacy Benefit Manager.
• The mail order myth is perpetuated by pharmacy benefit managers. They claim mandatory mail order saves the employer money. PBMs try to direct enrollees to mail order pharmacies owned by the PBM. The only peer-reviewed study on this topic questions whether employers actually save money. PBM profits from mail order are disproportionate to the savings, with the lion's share going to PBM profit instead of the plan client who pays the bills. Another report explains how full transparency in PBM contracts is the only way to know whether mail order results in savings and whether the savings are being passed along to employers.
• Just when you thought it couldn’t get any worse, ANOTHER layer of business consultants is siphoning health care dollars by advising employers on which pharmacy benefit manager to work with. And that consultant is often taking paybacks from the pharmacy benefit manager, the very entity it’s supposed to be scrutinizing for the employer. So who can employers trust? Demand full transparency and disclosure, plus the right for a full audit at any time as you would in any other contract.