Posted on Apr 28, 2020


The Tale of Two PBM Pricing Models: Post 5

Reality is that a plan sponsor cannot simply rely on theory. Plans should embrace an audit of their contract to assure that what is intended in practice is delivered. For our clients that move to the pass-through model, we do a savings analysis to answer the question for the plan sponsor as to whether the unit cost did decrease in each therapy class from lower-cost alternatives without increasing the length of time the member is on medication. The answer of interest is whether the savings will be equal to or greater than the difference in the discount and rebate offerings between the two-pricing models.
In closing, we recommend using a pharmacy-consulting firm to do an annual financial audit. An audit can help a plan sponsor fully understand their PBM contract and areas where the contract can be strengthened to favor them versus the PBM. For more information, please visit our website at or call us at 225-927-1941.
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