Reverse Your Rx Drug Trends
Prescription Drug Costs Are Like A Runaway Train. Annual Cost Increases In Recent Years Have Averaged 7% to 15%, and Projections Reflect Similar Increases In the Future.
Here Are A Few “Starter” Ideas For Reversing This Run-Away Trend. Contact Pharmacy Benefit Consultants, And We’ll Provide You With Still More:
Renegotiate Your PBM Contract: Most PBM/Client contracts enable PBMs to generate “profit spreads” in numerous ways, rather than requiring PBMs to “pass through” all potential savings to clients. Thus, the AWP Definition in PBM/Client contracts enables PBMs (and retail pharmacies) to retain all “bulk purchase savings”. MAC Definitions allow PBMs to charge essentially whatever they want for generic drugs. And PBMs keep virtually all manufacturer payments and discounts through a host of boilerplate terms PBMs include in clients’ contracts.
Accordingly, the “key” to reversing your ever-increasing drug costs is to amend your current contract, or draft and execute an entirely new contract. Pharmacy Benefit Consultants - in contrast to other consulting firms - will provide your firm with a lawyer knowledgeable about contracts and all PBM contracting “games” to enable you - not your PBM - to benefit from numerous available savings.
Conduct A Sophisticated “RFP” (Request for Proposal): Most RFPs prove to be of little or no value. Purportedly sophisticated consultants “re-price” their client’s claims tapes to analyze the financial savings that might result from using each competing PBM’s purported pricing; However, the “winning” PBM almost never provides in an executed contract the pricing that the consultant analyzed. Similarly, competing PBMs make oral and written promises to “win” consultants’ RFPs, but the winning PBM’s promises are almost never memorialized into the client’s actual contract with the PBM.Pharmacy Benefit Consultants conducts its RFPs differently. PBC drafts an entirely different form of PBM Contract for its clients, and requires competing PBMs to agree to all contract terms — or be eliminated from the RFP. PBC also uses the RFP’s leverages to force PBMs to provide better and better pricing terms and pricing guarantees, and then requires each PBM contestant to bind itself in an executed contract to the terms the PBM has proposed — before a PBM “finalist” is selected.As a result, when our RFPs are over, our clients have obtained the best pricing terms that are available, and PBMs cannot escape the promises they have made. PBC also has never - and will never - accept any money from PBMs, and we’ll execute a written Conflict of Interest Disclosure Form to prove it. Will your consulting firm do the same?
“X-Ray” Your PBMs’ Drug Costs, and Your Employees’ Drug Use: Virtually all PBMs tout their ability to generate high generic drug use, but fail to mention that they are retaining much of the savings available from generic drugs.To end PBMs’ practices, our firm has developed the ability to “X-Ray” our client’s claims data to quickly assess a PBM’s average invoiced cost for commonly used generic drugs. Our drug “X-Ray” also determines the extent to which a client’s employees are using high-cost or low-cost drugs, and then projects exactly how much our clients can save by (i) renegotiating their contracts to force their PBM to charge an appropriate price, and (ii) incentivizing employees to use lower-cost drugs.Rather than squandering money on high-cost audits which almost never result in recovered dollars, retain our firm to run a low-cost “X-Ray” and thereby learn what you need to know to dramatically decrease your costs.
Require “Pass-Through Pricing”: PBMs frequently reimburse retail pharmacies for dispensing drugs to your plan members using one price, but invoice your company for the same drugs using an entirely different and higher price. Similarly, PBMs purchase drugs for their mail pharmacies and specialty drug pharmacies at one price, but invoice you for the same drugs at far higher prices. Eliminate all contract language that allows such practices, and draft contract language that explicitly requires retail, mail and specialty drug “pass-through pricing.”
Require “Pass-Through” Of All Manufacturer Payments and Discounts: Federal and state litigation - as well as numerous lawsuits filed on behalf of individual companies - have alleged that many PBMs have wrongfully manipulated their contracts with manufacturers to deprive PBM clients of savings.To ensure that all savings from manufacturer payments are passed through in the future, clients should immediately require that PBMs amend their contracts, or negotiate new contracts.PBMs must be contractually obligated to (a) provide full disclosure of all contracts with all manufacturers and third parties; and (b) pass-through all payments and discounts obtained from all manufacturers and third parties.
When Pharmacy Benefit Consultants conducts PBM RFPs - and drafts and negotiates new PBM contracts - for our clients, we ensure that PBMs pass-through to our clients ALL FINANCIAL BENEFITS, in their entirety, from ALL third parties, including drug manufacturers, drug wholesalers, drug distributors and repackagers.
Contact Pharmacy Benefit Consultants — Implement All Of The Above Cost-Saving Strategies And Learn About Still More.