Make Prescription Drugs More Affordable
According to Mercer’s 2018 National Survey of Employer-Sponsored Health Plans, 68% of employers say that managing specialty pharmacy is “important” or “very important.” Pharmacy costs have a significant impact on both employees and companies’ spending, so it’s no surprise that existing and future employer-led strategies will aim to reduce the burden.
- Conduct a detailed review of your pharmacy contracts. Look for and ensure aligned interests with your PBM by requesting revenue breakdowns over the life of the contract.
- Seek acquisition-based pricing for mail and specialty claims. Contracts based on a discount off AWP results in huge revenues for the PBM that only increase as specialty drug costs rise.
- Require independent, clinically focused prior authorization. PBMs lack incentive to provide the detailed oversight required to produce savings for employers. Find an independent entity to conduct prior authorization in line with your financial interests.
- Educate members on highest-value pharmacies. With transparent pricing at retail, grocery and discount stores like Walmart and Costco, drugs may be significantly less expensive than other drug stores.
Net Effect on Consumers
Overall, the PBM industry claims to provide significant cost savings for end users. For example, in 2015, CVS Caremark said that it reduced its plan members' prescription drug spending to 5%, down from 11.8% in 2014. However, such conclusions can be controversial. A 2013 investigation of PBM marketing from Fortune Magazine showed: Drug pricing is difficult to untangle, and customers have no way of knowing how much they are saving, if anything.