The cost of prescriptions continues to be a top health care issue and a significant concern for most Americans. Of those taking prescription drugs, one in four say they struggle to afford their medicines. Brand prescription prices continue to increase and new drug therapies offering treatment advancements may have significant go-forward cost management implications.

In addition to concerns of drug affordability, regulators and payors are demanding increased transparency from the pharmacy benefit management (PBM) industry. Most PBMs claim “pass-through” or “transparent” practices, however definitions vary. This creates confusion in expectations, understanding and achievement of reduced drug cost. Currently, the three largest PBMs control approximately 80% of the total pharmacy benefit market. The traditional PBM model often operates on hidden revenue streams and benefit when drug costs increase as they retain a portion of discounts, rebates and fees negotiated on behalf of clients. These challenges came to a head in 2022 as PBMs received the lowest satisfaction rate in three years.

Fortunately, alternative PBM models exist and offer a proven track record of generating comparative, real savings for both plans and members while supporting desired health outcomes. For example, despite seeing notable increases in brand drug list prices and utilization across a variety of covered medicines in 2022, Navitus Health Solutions clients on average experienced minimal and controlled year-over-year total drug cost change.  In fact, Navitus’ 2022 Annual Drug Trend Report highlights that 49% of commercial plans saw their net drug spend decrease compared to 2021.

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