Pharmacy costs are becoming a larger percentage of health plan spend. Even though patents expire, the cost of both generic and name brand drugs continue to rise. Pharmacy Benefit Managers (PBMs) are the “middle men” in this category of spend. Many PBM contracts are convoluted and not written in the best interest of the plan sponsor. Rebates belong to the plan sponsor, no one else. As a Fiduciary of plan assets, it is incumbent to purchase prescriptions at the most favorable price to the plan.
An assessment of your prescription costs with a forensic review of your contract will be very revealing. Our transparent approach provides pass-through pricing for all prescriptions and a contract that is written to protect the plan, not the pharmacy benefit manager. There is no “hidden agenda”. Due to a unique patented process, you receive 100% of all rebates at point of sale. You receive a pure pass-through of all costs. There is no mark up. It is truly a cost-based platform. Employees would have minimum disruption, if any. The pharmacy benefit manager’s only source of revenue is a monthly admin fee per employee.
- What if your pharmacy contract did not allow for spread pricing?
- What if your pharmacy contract returned 100% of rebates back to your plan?
- What if your pharmacy contract allowed for full audit rights?
- What if your employees were able to secure 90 day supply of name-brand maintenance drugs (and specialty drugs) from a Congressionally designated Tier 1 country that reduced cost in excess of 50%?
- Domestic PBMs are plentiful. We key on contract provisions, for example:
- Spread pricing – our contracts do not allow.
- Rebate retention – our contracts return 100% of rebates to the Plan.
- Reclassification of drugs – our contracts do not allow.
- Audit capabilities – our contracts provide for unlimited audit access to all claims data
- Supplemental International Mail-order will reduces the cost of covered name-brand drugs more than 50%.
|Client||# of Lives||Prior PBM||Prior Spend (PMPM)||Current Spend (PMPM)||Change in Spend||Percent Savings||Annualized Savings|
|Employer B||4.409||Blue Cross||$73.07||$64.86||$8.21||11.2%||$434,371|