Overview of Transparent Pharmacy Benefits

There is a lot of confusion about pharmacy benefits and what is really going on within the data. The industry has intentionally made it more confusing and obfuscated than is necessary. As a result, purchasers of pharmacy benefits have lost control of unnecessary rising costs.

Pharmacy benefits have become 20-25% of the average employer’s healthcare spend. Specialty Pharmacy has everyone’s attention with $100,000+ therapies and more on the horizon. Rebates are being touted and can generate significant payment to the employer, but rebates also can be a challenge. What if PBMs are choosing which drugs are on “preferred” status based on financial position as opposed to clinical efficacy? Who is overseeing this? Unfortunately, transparency is hard to find.

Supporting Transparent Pharmacy Benefits is positive for almost all parties involved. There are literally thousands of opportunities where, with proper information and education, participants can make better financial choices and even improve the chances of a quality outcome. Purchasers of health care and especially pharmacy benefits can take back control while working with their PBM or PBM service partners to improve outcomes and increase the value of their overall Rx benefit.