- Hire a PBM willing to sign on as a fiduciary; transparent speak isn’t enough.
- Promote member use of manufacturer coupons for brand and specialty drugs. PBMs should communicate availability of all coupons to members.
- Pay only Cost Plus (no spreads or mark-ups) for all prescription drugs.
- Include a semi-annual market check in the contract language.
- Attain and exercise full auditing rights.
- Require the PBM to identify and pass along all sources of attributable revenue from manufacturers. Limiting agreements to ‘rebates’ leaves money on the table.
- Use Reference Pricing — different and much more effective (when applied) than an AWP reporting service.
*Cost Plus = [Acquisition Cost + dispensing fee + admin fee] minus Co-pay
Due in large part to specialty drugs, we are clearly entering a time of higher costs. Payers whom act now are in the best position to assure continued access to quality care for their members while effectively managing rising drug costs.
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