The Choice to Stay Involved – Ask These Critical Questions
It’s Election Day, and millions of us are making important decisions about leadership and public policy. It’s important to be involved in these choices and to stay informed about the issues that affect our livelihoods and finances.
In the same way, employers have a choice about how their pharmacy benefit is structured and which Pharmacy Benefit Manager (PBM) administers the program. Like voting, involvement and informed decisions make all the difference. The pharmacy plan can be “carved-in” as part of the medical plan, or it can be “carved-out” as a separate program. There are important considerations to this choice and employers should know how they impact their plan from both a financial and utilization standpoint.
Lately the debate has become more active, with many plans advocating the advantages of carving-in pharmacy, claiming cost savings and better health integration. Before making such a choice, plan sponsors should ask critical questions about the structure of their prescription drug benefit in the interests of their employees and themselves as stakeholders:
- Who controls the PBM contract – and are you even a party to the contract?
- How do you know the contract, including allocating discounts and rebates, is being followed?
- Who decides which PBM administers the Rx benefit and whether they are providing the best value for you?
- Are rebates and discounts subsidizing your costs, or somebody else’s?
To stay informed and involved, employers need to be a party to their pharmacy program contract. Keeping the terms of the contract transparent is the best way to maximize the advantages of an expertly managed prescription drug benefit that won’t leave you in the dark about where the dollars are being spent. You have the vote!