The Complexities of How Pharmacy Benefits Work

The prescription drug industry has changed dramatically. It can be difficult to navigate between continual regulatory changes, new therapies and skyrocketing drug costs to ensure the best decisions are being made for your employees, while preserving cost. With the increasing costs of pharmaceuticals, it's essential for employers to have a good understanding of the complexity of how pharmacy benefits work

Reviewing Your Options
Much like anything business owners must consider putting money into, employers want to "kick the tires" to see if they're getting the best deal on their prescription drug spending before committing to a contract. A common issue that employers run into though, is that they don't know how to do this when it comes to pharmacy benefits, or who to depend on. And unfortunately, just plopping proposed discounts on an excel spreadsheet are meaningless due to financial optics that can make the deal look better than it really is. Getting a professional second opinion about your prescription drug plan may help to make the decision easier, lower drug costs significantly, and reduce out-of-pocket expenses for your employees.

The Devil is in the Details
Some employers change PBMs thinking their new deal is better only to witness costs dramatically rising. While the purpose for hiring a PBM is to help curb the costs of medications, some PBMs have their best interest in mind, rather than the client's. Discounts and rebates afforded may not be passed through to clients, or they may be directing clients to specific mail order or specialty pharmacies because they receive a percentage of the cut rather than looking out for more cost effective solutions for the plan sponsor or employer. This is why it's especially important to have a thorough understanding of your contract agreement with your PBM and to review your plan and claims periodically to ensure your PBM is providing the agreed upon services at the prices negotiated. The bottom line is when it comes to PBM selection, the devil is in the details. And what you don’t know CAN hurt you.

Get What You're Paying For
The only way to quantify that you're getting the best bang for your buck is via an upfront claims re-pricing. No surprises. Our knowledgeable staff of professionals continually monitors and audits claims to ensure contractual pricing, programs and drugs are being processed accurately.  Our strategic analysis, reporting, account management and clinical oversight - combined with our pre-negotiated PBM coalition best-in-class pricing – have resulted in significant savings to employers.  Some up to 20%! Through our group purchasing contracts, we offer very competitive pricing typically only available for very large employers.  We offer a best-in-class portfolio of programs, unique customized solutions, choice and flexibility.  

So, if you're a self funded employer who feels you're paying way too much for your prescription drug plan – we have solutions for you! Contact a trusted and experienced Pharmacy Benefit Management consultant today. We'll help you understand the complexities of how your pharmacy benefits work and help you pinpoint the areas that need improvement to save money in the process!

Make sure to subscribe to our blog and social media accounts to learn more about what we do and stay up-to-date on the ever-changing world of pharmaceutical benefit services!

Affordable Best-in-Class 

Pharmacy Benefit Management Solutions

Synergy Pharmacy Benefit Consultants, LLC
2111 Bagnell Dam Blvd #37
Lake Ozark, MO 65049


Popular posts from this blog

The Diabetes Dilemma - A Growing Epidemic

TAKE FIVE – Validate: A Cliff Note Series on Pharmacy Benefit Management

TAKE FIVE – Facilitate: A Cliff Note Series on Pharmacy Benefit Management