As the person responsible for managing employee benefits at your company, when was the last time you read through your pharmacy benefit management (PBM) contract? We don’t expect that many people pour through all the details of a 30-page contract. But if you haven’t questioned the terms of that contract, then your company is paying more than it should.

It’s difficult for any employer to develop a level of expertise needed to be an educated consumer of PBM services. However, asking your PBM for answers to key questions is a simple place to start. And it could save your company, and your employees, a lot of money.

If your PBM can’t, or won’t, answer your questions to your satisfaction, it’s time to reconsider your relationship. You should have access to the information you need to make the best healthcare decisions for your employees’ good health and your organization’s bottom line.

Jim Harenberg, vice president of Strategic Solutions at Apex Benefits and leader of ApexRx Pharmacy Benefits Consulting services, says there are at least ten key questions every employer should ask and get answered by their PBM.

Here are just the top three:

  1. How much am I paying you? This is the most critical question to ask your PBM. Many employers don’t know the answer because their PBMs don’t fully disclose how much revenue they are receiving from the services they are providing. Can you think of any other vendors you work with who haven’t disclosed how much you’re paying for a service?
  2. How do you define generic medications? Generic medications are typically defined as the first alternative to a brand-name medication. Yet many PBM contracts require two or three branded medications to be on the market as alternatives before an employer receives the savings associated with a generic medication. Make sure your contract reflects the best savings on generic medications for your organization.
  3. How do you define specialty medications? Is a specialty medication truly a medicine that is high cost, difficult to store or tricky to administer? Or is it a regular medication that’s being used to treat a special condition – leaving a loophole for the PBM to pad the calculation on their discount guarantee?

Watch Jim’s video below to see more. Download a full list of all 10 questions to ask your PBM.

Learn more ways to provide the best health benefits to your employees at the most affordable costs at an upcoming free educational event, “A Prescription for Managing the Impact of High-Cost Medications,” on November 13, 2019. Learn more and register here.

Would you like help evaluating your pharmacy benefits program or finding ways to control costs for you and your employees?

Contact the ApexRx team at