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Evaluating your PBM evaluation process: Are you aligned with client goals?

While the medical health care industry is transitioning from the broken fee-for-service model by incorporating capitated payments and responsible risk-assumption, pharmacy pricing structures still very much value volume.

By Dr. Polina Kogan | October 07, 2019 at 02:02 PM
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Saving $500 on a $6,000 purchase is obviously not as good as saving $100 on $4,500, but does your PBM evaluation process recognize that?

For many health benefit plan sponsors and their advisors, the evaluation process used to compare pharmacy benefits managers (PBMs) keeps drug costs higher than they should be by measuring their value with metrics that reward rebates rather than net costs. An RFP process that “spreadsheets” acquisition discounts, rebates per prescription, and administration costs typically lacks the information that plan sponsors need to recommend the option with the lowest overall costs and doesn’t account for utilization management or improved clinical outcomes.

Related: PBMs lose out to pharmacists in Ohio budget deal

While the medical health care industry is transitioning from the broken fee-for-service model by incorporating capitated payments and responsible risk-assumption, pharmacy pricing structures still very much value volume.

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