The health care industry is complex and difficult to understand with many intricacies that most consumers and employers are not educated on. A complete lack of transparency has led to many areas of hidden fraud, waste, and abuse. Combined, these three areas lead to an estimated 1% of prescription drug costs. Although it does not sound like much, this amounts to hundreds of millions of dollars for health care payers like yourself.
Many larger companies and nonprofits hire a Pharmacy Benefits Manager (PBM) to negotiate discounts with pharmacies and drug makers for their employee’s prescriptions. These PBMs determine where patients fill their prescriptions, what drugs are available, and how much pharmacists are reimbursed for dispensing them.
However, many traditional PBMs lack transparency leaving pharmacists and companies frustrated with hidden abusive practices. These practices allow for PBMs to make huge profits from filled prescriptions by not actually lowering the cost, but instead controlling the cost so it appears to remain steady over time. This abuse of power, not only harms pharmacies, but also many companies as it impacts their bottom line and puts pressure on the benefits managers who work hand-in-hand with the PBM.
Although this is just one area of abuse within the system, there are many others that affect today’s consumers. It is nearly impossible for you to discover what care and coverage is best for your company and your employees without seeing all the options available.
Give us a call today at 888-633-5850 to talk with a BCR specialist on how we can help to navigate this maze of madness.