Problem: High Cost Pharmacy
During our analysis, we found that the employer’s plan was not receiving the best pricing options for pharmacy. The Pharmacy Benefit Manager (PBM) was keeping a significant “spread” – charging the plan more than the drugs cost the pharmacy. This is a common practice with insured plans. The formulary also included high rebate drugs that were no more effective then lower cost drugs. Rebates were 100% retained by the PBM. After taking over the program, we found four high cost drugs costing more than $5,000 per person per month.