Owning PBMs

  • by: Peter Pitts |
  • 07/21/2023
It’s time for employers to wake up and recognize the dangers of Prescription Benefit Managers. In fact, it’s long overdue considering that (at least in theory if not in practice) PBMs are supposed to be working for employers. The reality is quite different.

PBM practices are driving up costs for patient (a large portion of whom as also employees of companies who contract with PBMs to keep their corporate healthcare costs down). And employees are complaining – about higher co-pays, about co-pay accumulators, about non-therapeutic switching, about ever more aggressive prior-authorization. And do you know who else hates these cold and calculated tactics? Healthcare providers.

Another group that’s finally recognized these problems are the human resources departments of the companies that do business with PBMs. Employees unhappy with their healthcare are employees with one foot out the door. Not surprisingly, the Great Resignation is (at least in part) being driven by the higher co-pays, restricted access, and overall “profits over patients” mentality of many employers.

But the blame lies less with employers and more with the dishonest rhetoric of the PBMs themselves. Most decisions about PBM contracts are made by middle management who generally renew their contracts without much debate or negotiation. It’s become a “take it or leave it” situation.

It’s time for HR to wake up and do their jobs. And now there’s a terrific new primer, a real “how to” guide to help them take back control. Created by the National Alliance of Healthcare Purchaser Coalitions,A Playbook for Employers: Addressing Pharmacy Benefit Management Misalignment” is an absolute must-read. It’s a how-to-take-back-control manual for human resource professionals worth their salt.

(“Misalignment" -- such a polite term for such a dire situation. But they don’t call it “killing them with kindness for nothing.)

The playbook’s strategic recommendations for purchasers (aka: "employers") resides in three key buckets, (1) work with partners who work with you, (2) evaluate and manage with a balanced scorecard, and (3) own the relationship.

Own the relationship.

Yup, it’s time for employers to step up before their employees step out. Knowledge is Power.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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