A new playbook from the National Alliance of Healthcare Purchaser Coalitions lists the top 10 concerns employer health plans have with pharmacy benefit managers (PBMs):

  1. Promoting drugs with higher prices when lower-price options are available
  2. Offering preferred coverage to a branded drug when a generic is on the market
  3. Covering specialty drugs in situations that are not supported by clinical evidence
  4. Rolling out automated prior authorization, which caused rates to grow by more than 90%
  5. Labeling generics as branded products or vice versa to manipulate discounts
  6. Deploying tactics that encourage waste such as early refills or automatic 90-day refills
  7. Covering high-cost, low-value products such as those with an over-the-counter option
  8. Replacing rebated drugs with 340B drugs and then failing to pass the 340B savings on to the plan sponsor
  9. Using a narrow definition of rebates, which allows the PBM to keep 50% or more of the revenue
  10. Holding plan sponsors “hostage” on contract terms, financial guarantees and provisions

MedBen Rx has experienced these PBM tactics as well as a few others. The common denominator is that often, the PBM pockets money that rightfully belongs to the employer plan, under the guise that they are actually saving the employer money.

The guide also offers a recommendation to employers: “Work with partners who work for you.” That means, among other things, “Total transparency of pass-through prices and all manufacturer payments to PBMs, along with a commitment to value (to plan and plan members).” 

Through our expanded pharmacy solutions, MedBen Rx practices total transparency and maximum value… no games and no hidden costs. You pay what pharmacies pay, plus a dispensing fee and a PBM per claim fee. We make no money off the drug, and 100% of paid rebates go back to the plan. Simple as that.

See for yourself the difference MedBen Rx can make in reducing your drug spend by contacting us at 888-627-8683.