To people outside the health care industry, the role of the pharmacy benefits manager (PBM) can be a bit unclear. Simply stated, PBMs act as intermediaries between insurers (or, in the case of self-funded plans, employers), drug companies, pharmacies, and consumers. In this role, they negotiate drug prices, develop formularies, and process claims.
Not surprisingly, PBMs carry a lot of clout. As Vice News notes, the top three PBMs “influence more than 80 percent of employer-sponsored prescription drug coverage.” This influence extends to how much drugs cost… and ultimately, how much you pay for them.
A PBM’s negotiation power extends to discounts and rebates from drug companies — and by holding a portion of these back, PBMs can realize substantial profits. To guard against this, MedBen has partnered with PBMs that share our belief that rebates and discounts belong to the employer. And not just “some of it” or “most of it” – 100% goes back to the client.
As a means of further reducing Rx costs, MedBen recently partnered with a pharmacy services administrator (PSA). Unlike traditional PBMs that price medications based on an inflated wholesale price, our PSA uses the true cost a pharmacy pays for a drug and adds a dispensing fee that fairly compensates the pharmacy. This “cost plus” approach better reflects the drug’s actual price.
MedBen draws on multiple strategies to keep your pharmacy costs as low as possible. Learn more about how we do it by visiting MedBenRx.com or contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.