- Employers in a new study said their pharmacy benefit managers (PBMs) are key in handling prescription drug benefits, but what PBMs do exactly is a mystery, according to the National Pharmaceutical Council (NPC). The study for the NPC by Benfield, a Gallagher Benefit Services division, surveyed 88 employers with 5,000 or more workers.
- The study found that only 30% of respondents understand their PBM's contract details, 40% understand their PBM's guarantee in performance and 63% said they don't know how their PBM makes money.
- NPC says the respondents recommended that PBMs be more transparent about their contract details, simplify their contracts, focus less on rebates and clarify how they make formulary and exclusionary decisions so patients get better value.
Pharmaceuticals, particularly specialty drugs, are major drivers of healthcare costs. Healthcare is shifting to a value-based model, which focuses on getting the best outcomes while slowing the rise in costs — and high value pharmacy is a big part of that.
The problem is that a lack of PBM transparency makes it difficult to see how and why they fit into the employee benefits scheme. PBMs certainly aren't without controversy; Anthem accused Express Scripts Holding Co. of overcharging by $3 billion dollars and has since opted to create its own drug plan.
But it is unlikely that they will be removed from the system entirely. Some PBMs, including CVS Caremark, have even stepped up to address the opioid epidemic, a major health crisis that has impacted employers' attempts to recruit and keep employees healthy.