Employer Journey

Employer Journey

Prescription Benefits Redesign: Using Common Sense to Promote Value for All Stakeholders

Below are excerpts from an employer story. This journey involves a large, self-funded employer with approximately 40,000 employees. Read the entire article here

There has never been a time quite like today when the use of old fashioned common sense to design prescription drug benefits is critical.  There is a tsunami in the distance called the specialty drug pipeline and those who do not prepare now will suffer great losses.  This employer case study will guide you through a journey of possibilities……

….PBMs were not assuming an educator role, as their major focus was to make sure they developed formularies to guide employers in obtaining the best rebates from the drug manufacturers because a portion of those rebates were typically shared with the PBMs. This is addition to the administrative charges already being paid by employers. After all, the more rebates obtained, the lower the administrative charges would need to be….right?

While medications that cure acne, toe nail fungus, impotence and hot flashes may provide some value to consumers, they provide little if any value to employers.  Why then, should employers cover such medications in the same ways as those of shared value? Can we develop a benefits design based on shared value that achieves intent and is accepted by employees with little or no noise?

We must call the PBM account manager and lead clinical pharmacist and ask them to take off their PBM hats and walk with us down a visionary path where the words “we can’t” get replaced with “we could, if”….