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By Truven Staff

How to Make "Cents" of Your Pharmacy Benefits

Marie Bowker imageFactors like increasing specialty drug costs, fewer covered medications, and fluctuations in participating pharmacies can create a lot of confusion. With all these moving parts, employers and health plans may be struggling to figure out how to not only understand pharmacy benefit expenses and reduce costs, but also get more out of their Pharmacy Benefit Manager (PBM) contract.

Questions employers and health plans should be asking right now include:
  • How can I negotiate a better PBM contract that protects my interests?
  • Are there ways to stem the continuous increase in costs with my current PBM or do I need to branch out?
  • How can I reduce my pharmacy costs without cost-shifting to members? 
  • Are there fine-print clauses in my current contract that could be preventing cost-savings?
  • Does my current PBM contract have flexibility if our needs change in the near future?
  • Do I have the right in-house resources (expertise and available time) to do an objective, thorough evaluation or full PBM RFP?
The right data, combined with seasoned analysts, can help employers and health plans answer all of these questions and more.

As objective outside partners to our clients, we’ve seen organizations reduce their drug spend by 8 to 15 percent. Recent successes include:
  • Conducting PBM vendor negotiations saved more than 17 percent on prescription drug costs, for an overall ROI of more than 50:1
  • Performing a formal RFP generated more than 25:1 ROI, or 10 percent savings on drug spend
  • Negotiating 13 percent savings with more favorable contract terms with current PBM

Plan sponsors can find more details that could shed some light on their PBM contract by downloading our compilation of PBM Contract and Negotiation Success Stories.

Marie Bowker
Senior Director, Practice Leadership
Categories: Employer, Health Plan