In December 2023, the U.S. House of Representatives passed the Lower Costs, More Transparency Act, a comprehensive, bipartisan bill aimed at increasing price transparency across the healthcare industry and lowering medication costs.
Passed by an overwhelming majority (320-71), this move requires group health plans to make personalized pricing information available to consumers; publicly post in-network negotiated rates, prescription drug prices and out-of-network allowed amounts; and to hold hospitals, labs, imaging providers and ambulatory surgery centers to similar price-transparency rules.
But to get the most of these measures—especially in the short-term—consumer advocates will have to work together to navigate the bill’s opportunities and restrictions. This makes the recent teaming of Pharmacy Benefit Dimensions and not-for-profit Transparency-Rx good news for anyone working to usher in a new era of clearly messaged, customer-first healthcare.
As a wholly owned subsidiary of Independent Health, Pharmacy Benefit Dimensions has been helping customers and members gain greater control over their prescription drug benefits for 25 years. Today, the company serves more than 4,000 employer groups and nearly 500,000 members in all 50 states, comprising a broad range of industries, including manufacturing, hospitals, county governments and more. The company is recognized for its quality and service, achieving a 5-Star rating by the Centers for Medicare & Medicaid Services for its Medicare Part D prescription drug plan for three consecutive years; and has been lauded by consumers eager to find cost savings.
Led by transparent pharmacy benefit managers (PBMs), Transparency-Rx is a consortium of industry experts and stakeholders that represents nearly 15 million individuals across all 50 states. Launched in September 2023 with a forward-looking policy platform that embraces many of the industry changes endorsed by Congress and advanced by state policymakers, Transparency-Rx has brought together names like AffirmedRx, Liviniti, and Navitus Health Solutions for a mission that focuses on such items as reducing costs for plans for patients; remaking markets to accommodate sustainable access to life-changing prescriptions and break-thru medications; and empower technology to better inform and engage patients and plans.
“We’re thrilled to welcome Pharmacy Benefit Dimensions to our membership of transparent PBMs dedicated to fostering sound drug policy that lowers costs,” said Transparency-Rx Managing Director Joe Shields. “The transparent PBM movement continues to grow, fueled by purchasers demanding lower costs and policymakers’ focus on clearer prices.”
“Pairing our value-based approach with a variety of transparent cost-savings programs has resulted in our clients saving 15 to 20 percent on their annual drug spend,” said Pharmacy Benefit Dimensions President Lynne Reilly. “Joining Transparency-Rx is a testament to our dedication to advancing affordability in health care. We are excited to collaborate with like-minded organizations and contribute to meaningful initiatives that empower patients and stakeholders across the health care spectrum.”
Together, Pharmacy Benefit Dimensions and Transparency-Rx—along with other members of their growing coalition—are intent on mobilizing the tremendous opportunities enabled by the Lower Costs, More Transparency Act, and not a moment too soon.
According to the U.S. Bureau of Labor Statistics, the country’s Consumer Price Index (CPI)—the average change in prices paid by consumers for various goods and services—has grown at an average of 2.5 percent per year over the past 20 years, while the CPI for medical care has grown at an average rate of 3.2 percent per year. These ongoing increases in healthcare and its components have amplified the need for price transparency for consumers, each eager to make informed and financially manageable decisions for their own wellbeing.
That’s the aim of organizations and individuals now supported by government action; and with the formation of more consumer-focused coalitions, real improvements can occur in a service sector that’s sorely in need of change.
To learn more about Pharmacy Benefit Dimensions and its capabilities, click here.
Photo by AbsolutVision on Unsplash
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