Getting Help From Your Pharmacy Benefit Manager

Using a Pharmacy Benefit Manager (PBM) to offer a robust pharmacy benefit program to your employees is something that should offer lower prescription drug costs, happier and more loyal employees, and help your company standout among competitors. What should you look for in a PBM to achieve these results and what is required from the PBM to meet your goals? How can you make sure you have both the right PBM to offer the lowest net drug costs (to the company and employee), best member service, and right plan design? Let’s talk about what your PBM may be doing right, and what could be improved to reach your goals.

Response Time

When you sign up with a PBM; that PBM will designate an Account Manager to your group. The Account Manager’s mission is to make sure your companies pharmacy benefit program is served properly. This can mean many things depending on your desires from the PBM. Some groups like a quick response time, some groups want the formulary followed strictly to enhance rebate, others may want to cover everything and offer a more customer satisfaction driven plan, while some may simply want to drive down prescription costs. No matter what the goals are, they should be discussed between the group HR/Benefit Manager and the PBM Account Manager. The Account Manager should listen and develop a plan to accomplish the goals of the group. A good PBM Account Manager can make the difference in a group achieving the end result expected.

Reporting and Access to Data

 It may seem obvious but you would be surprised how many PBM’s don’t offer drug pricing transparency or access to claim history data. Saving money on prescription drug costs requires knowing you are paying a fair and competitive price for medications. The only way to know this is by having access to and reviewing pharmacy claims data. It’s often the task of the groups Benefit Consultant to assure the right PBM is servicing their client. Data is the key to making informed decisions to reduce your prescription costs without reducing your coverage.

Specialty Drug Costs

Specialty pharmacy medications should be a focal point for any group’s pharmacy plan design. The rise of drug costs is significantly tied to the availability of high cost specialty medications that treat and sometimes completely cure, rare disease states. Your Benefits Consultant should work with your PBM to assure the PBM is able to effectively manage specialty costs, through the plan design chosen. For example, many plans are moving from a flat rate copay to a coinsurance for specialty pharmacy medications. It is extremely helpful to have a PBM that helps members enroll in copay relief programs available through pharmaceutical manufacturers. Copay relief programs (often referred to as copay cards) can drastically lower both member out of pocket costs, and group plan costs for high cost specialty pharmacy medications.

Effective prescription management can lead to better health outcomes, lower prescription costs, and happier employees. Getting help from your PBM should not be a hassle, but instead should make offering a robust pharmacy plan simple and affordable. This starts with choosing a transparent PBM, who offers timely access to claims data, and a knowledgeable and responsive Account Manager.

NICK RISTAU

SENIOR ACCOUNT MANAGER, MDRX