The Employer's Guide Blog for Overseeing PBMs

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[Podcast] Rx Drugs and the U.S. Health System – A Conversation About Drug Prices

This is an awesome podcast and you can feel the tension between the manufacturer (Pfizer) and PBM (Express Scripts). Unfortunately, none of the speakers took the bait. Grab a cup of coffee or your favorite beverage and listen to the entire hour. 

It’s nice to be able to fill in some of the holes when dealing with a complicated issue. So, I strongly recommend you read these two blog posts before listening to the podcast. 

1)  How Pfizer set the cost of its new drug at $9,850 a month 
2)  Express Scripts generates top-line revenue of $76.63 per claim! 

My big takeaway is that Express Scripts is extremely arrogant; lecturing manufacturers on how to run their businesses. Imagine for a second the strong arm tactics ESI might use when negotiating rebates not for the sole benefit of plan sponsors but its own pockets. Click play to listen…

Keep this point in mind. While Dr. Miller stresses transparency to clients, he failed to define transparency. There is no standard industry definition for transparency thus each PBM approaches it very differently. I’d like to offer a standard industry definition for transparency. 
Transparency – the perpetual elimination of all hidden [PBM] cash flows and full disclosure of service revenues, including their sources, on a plan-specific basis.

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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