The Employer's Guide Blog for Overseeing PBMs

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New Hep C Pricing Model: A Game Changer for Self-Funded Employers

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For as long as I can remember pharmacy benefit managers have blamed pharmaceutical manufacturers for the high cost of prescription drugs. Drugmakers do share some of the responsibility but so to do pharmacy benefit managers.

Because it essentially eliminates the PBM mark-up, AbbVie’s pricing strategy for its new Hep C drug Mavyret is disruptive to the traditional PBM revenue model. Abbvie is not going to pay a rebate and instead price it [rebate] back into the list price in the form of a significant list price discount. This move forces non-fiduciary PBMs to consider Mavyret for inclusion in their formularies even though the pricing strategy is not aligned with their own interest of needing manufacturer revenue to protect top line revenue.

The looming question is will non-fiduciary PBMs include Mavyret as a preferred drug in the HCV therapeutic class on their formularies. It is less costly and as efficacious as any other drug in the HCV class so it should be a no brainer right? Wrong. If the PBM decides to exclude or list the drug as non-preferred it’s likely because their interests aren’t aligned with those of their clients’. Let’s wait and see.

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Tyrone Squires, MBA, CPBS

I am the proud founder and managing director of TransparentRx, a fiduciary-model PBM based in Las Vegas, Nevada. We help health plan sponsors reduce pharmacy spend, by as much as 50%, without cutting benefits or shifting costs to employees.

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