Switching to a transparent PBM model within these big three PBMs may eliminate some of these issues, but not all of them. Often, they promote a “pass-through” arrangement wherein you get to keep a portion of the rebates generated. But this is not transparency.
To achieve transparency and real cost control, employers must move to a genuinely transparent model with a PBM that is not one of the Big Three.
Transparent PBM pricing accomplishes many things, including:
- Elimination of Spread Pricing. Pay only a per-employee, per-month fee and/or a per-transaction fee.
- Improved Drug List. Your formulary (drug list) can be based on low-cost, high-efficacy medications instead of chasing rebates.
- Complete Rebates. All rebates are passed through, not just a portion. With a transparent PBM, the medication with the lowest net cost is promoted, whether a non-rebate-generating medicine with a low price point or a higher-cost medicine that, once the rebate is incurred, has a lower overall cost.
- Capture Manufacturer Coupons. These coupons offset the amount employees pay for the prescription. In traditional models, that information is not captured, so a member could meet their out of pocket max on paper, but not have actually paid it. Transparent PBM contracts allow you to track this information toward member accumulators.
- Maximize Alternate Funding For High-Dollar Specialty Medications. Specialty medications are one of the biggest cost drivers employers face today, with multiple million dollar drugs on the market. Alternate funding allows a way for employees to obtain their medication free of charge, while also saving the employer money. It's a win-win!
Switching to a genuinely transparent PBM can significantly lower prescription drug costs and improve employer cost control. Transparent PBMs eliminate spread pricing, pass through all rebates, and use alternate funding to reduce costs. This ensures that organizations save money while providing employees with life-saving and cost-effective prescription coverage.
