What Should You Look For In A Pharmacy Benefit Manager?

As an employer, managing the cost of healthcare benefits for your employees is likely one of your top priorities. One way to manage these costs is by working with a Pharmacy Benefit Manager (PBM), which negotiates drug prices and manages prescription drug benefits for your employees.

However, the PBM industry has faced criticism in recent years for a lack of transparency and accountability, which can contribute to higher drug costs for you and your employees. To address these concerns, it is important to choose a transparent PBM that is committed to passing on savings to you and your employees.

So, what should you look for in a transparent PBM? Here are some key criteria:

1. Pricing transparency: Choose a PBM that is transparent about its pricing and provides clear explanations of its pricing methodology.
2. Rebate pass-through: Look for a PBM that has a policy of passing through a high percentage of the rebates and discounts it negotiates with drug manufacturers to its clients and patients.
3. Contract flexibility: Choose a PBM that offers flexible contracts that allow you to customize your plan to meet the needs of your employees.
4. Customer service: Look for a PBM that has a reputation for providing excellent customer service and support.
5. Quality measures: Choose a PBM that has measures in place to ensure that patients receive high-quality care and have access to the medications they need.

By working with a transparent PBM, you can help ensure that you and your employees are getting the best value for your healthcare dollars. By prioritizing transparency and accountability in your PBM selection process, you can help control costs and provide your employees with access to the medications they need to stay healthy.

When considering a Pharmacy Benefit Manager (PBM) to work with, employers should ask the following important questions to ensure that the PBM they choose is transparent and meets their needs:

1. What is your pricing structure? Can you provide a detailed explanation of your pricing methodology and how you calculate drug prices?
2. How much of the rebates and discounts you negotiate with drug manufacturers are passed on to our organization and our employees?
3. Can you provide examples of how you have helped other organizations save on prescription drug costs?
4. What is your process for resolving disputes with drug manufacturers or other stakeholders in the drug supply chain?
5. How flexible are your contracts, and can they be customized to meet the needs of our organization and our employees?
6. What measures do you have in place to ensure that patients receive high-quality care and have access to the medications they need?
7. Can you provide references or case studies from other organizations that you work with?
8. What is your customer service and support like, and how can we reach you if we have questions or concerns?
9. How do you stay up to date with changes in the drug supply chain and regulatory environment, and how do you adapt to these changes?

Asking these questions can help ensure that you choose a transparent PBM that meets your organization’s needs and priorities. It is important to remember that a good PBM will work with you as a partner to help manage the cost of prescription drugs and ensure that your employees have access to the medications they need to stay healthy.