Managing the costs of prescription drugs, particularly for small to mid-size businesses, presents a challenge requiring innovative solutions. In the U.S., prescription drug spending totaled $500 billion in 2021, reflecting an increase of 7.3% from 2019, according to a March 2022 report by the Drug Channels Institute.
A 2021 report by the Centers for Medicare & Medicaid Services projects that overall national health care expenditures will see an average growth rate of 5.4% between now and 2028, which is faster than the Gross Domestic Product.
As costs rise rapidly, businesses with self-funded pharmacy plans need a way to keep costs down while still providing high-quality, effective prescription drug coverage. Some companies use pharmacy benefit management (PBM) firms to try and manage their health care costs. Having an understanding of how PBMs work and price their services is important in order to make sure companies are achieving what they set out to do.
PBMs administer drug benefit plans and negotiate drug prices to deliver lower costs to their clients. However, the typical PBM payment structure is complex, and most PBM firms often keep their negotiated rates proprietary. Limitations and additional requirements are not always made clear to end users. A recent report by Axios explains how some national PBMs’ business models make it difficult for employer clients to determine if they are getting the most out of the services provided.
By contrast, Pharmacy Benefit Dimensions (PBD) – a wholly owned subsidiary of Independent Health – provides a truly transparent, 100% pass-through model that other PBMs do not. PBD relies on clinically based formularies that pass savings along to the customer rather than capitalizing on manufacturers’ rebates.
PBD works on a model that takes into consideration high-quality drug coverage with the lowest net cost possible. Pairing this value-based approach with a variety of cost-savings programs offered by PBD gives customers options when it comes to choosing how their pharmacy plans are administered and how they spend their healthcare dollars.
PBD’s philosophy of transparency extends to plan participants, too. By taking advantage of PBD’s up-to-date online formulary tool, plan participants can stay informed on updates and changes to specialty medications, step therapy requirements, age, and dosage restrictions, and more. PBD also offers online tools for plan sponsors, pharmacies, and providers. Plan sponsor representatives can view prescription utilization, demographic information, claims history, and prior drug authorizations on an aggregate basis to make sure they’re getting the most out of their pharmacy strategy.
By staying current with pharmaceutical trends, PBD consistently offers the most cost-effective plans on the market.
Pharmacy Benefit Dimensions, accredited by the Utilization Review Accreditation Commission, has been helping customers and members gain greater control over their prescription drug benefits since 2005. Today, Pharmacy Benefit Dimensions serves more than 4,000 employer groups and nearly 500,000 members in all 50 states. Its customers comprise a broad range of industries, ranging from manufacturing to hospitals, county governments, and more.
To learn more about Pharmacy Benefit Dimensions and how its services may help your organization, visit its website.
Photo credit: Nastya Dulhiier on Unsplash
