How many ways is maintaining status quo with traditional Pharmacy Benefit Managers costing you?

I’ve mentioned previously that unlike nearly every other aspect of managing employer-sponsored healthcare, the service you pay for with traditional PBMs is typically incredibly difficult to determine how much is paid for each service.

I’ve also mentioned, that because of traditional PBMs incentive to maintain status quo, they will provide transparency and disclosure only as demanded by clients – you the plan sponsor.

Let me put into context how important understanding what you’re traditional PBM is doing for you and the price paid for the service. Take medication adherence and PBM outreach for example. And, diabetes as a chronic condition to consider:

1 out of 10 adults has Type 2 Diabetes and chances are you have a variety of plan members who are managing this chronic condition. Many project in 20 years-time, 1 in every 3 adults will have Type 2 Diabetes. There’s little question that adherence to medication prevents long-term effects of Diabetes.

So, understanding what your Pharmacy Benefit Manager is capable of with respect to identifying therapeutic gaps in care and out-reach to plan members who have fallen off care path is critically important. As well as knowing the cost of this service? Yes, of course!

The consequences of medication non-adherence are not only poor clinical outcomes but also unnecessary health care costs – Unnecessary costs that ultimately hit your health plan. Simply put, the total cost estimates for non-adherence are staggering.

I must reiterate this point – The agreement you sign with the PBM is the exact opportunity you have to understand what services are available and how you can leverage them to mitigate costs. And, transparency into price is an absolute must!