Are Pharmacy Benefit Managers Worth It? How Partnering with One Improves Patient Outcomes and Reduces Costs for Payers
Over the past few years, pricing transparency has become a major topic of interest for workers’ compensation and group health payers who use pharmacy benefit managers (PBMs).
Some payers are concerned that PBMs are contributing to high drug prices, and that they may be overcompensated for their services. Questions about pricing transparency began on the group health side, but, as they often do, the conversation has widened to include workers’ compensation. Many payers struggle to explain what they mean when they talk with their PBM about transparent pricing, and few understand the full extent of the programs and services their PBM offers to make the delivery of pharmaceutical care streamlined and efficient.
“Price transparency means something completely different from PBM to PBM, from payer to payer. It’s really a buzzword,” said Michelle Nack, senior vice president of strategy and commercial finance for Optum Workers’ Comp and Auto No-Fault.
“I always say to our clients, ‘What are you trying to understand when you ask about pricing transparency? Are you thinking you’re not getting enough savings from your overall program? Are you wondering if your price per medication is too high? What are you trying to achieve?’ ”
When payers ask about pricing, their concerns boil down to one central question: Am I getting good value from my PBM? In order to evaluate that, payers need to understand what services they’re receiving and the value these services bring to their overall pharmacy program.
PBMs can help cut pharmaceutical costs while offering critical claims management programs and support, improve therapeutic outcomes and — in the case of workers’ comp — reduce the amount of time it takes an injured worker to return to work, cutting costs over the long term.
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