White Paper

Are Pharmacy Benefit Managers Worth It? How Partnering with One Improves Patient Outcomes and Reduces Costs for Payers

As the media focuses on PBM pricing transparency, it’s important to consider all the benefits PBMs bring to the table.

White Paper Summary

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.

To learn more about Optum, please visit their website.

The Optum workers’ compensation and auto no-fault division works to collaborate with our clients to deliver value beyond transactional savings while helping ensure injured parties receive safe and effective clinical care throughout the life of their claim. Our innovative and comprehensive cost management programs include pharmacy care services, ancillary benefit management, medical services, and settlement solutions.

More from Risk & Insurance