PBMs should make 100% of their revenue from fees paid directly by their clients. This alignment of financial interests is essential to managing costs.
Coverage should be based on lowest net cost and value, not on rebate maximization or optimizing the profits of the PBM-owned pharmacy.
Full visibility of performance metrics is a critical foundation to holding the PBM accountable.
Fully aligned, value-based, transparent benefits are possible – for PBMs willing to use them, and for employers that insist on them.
Discover how EpiphanyRx is providing significant, ongoing savings for our clients in a way that no one else does.
We replace spread pricing, rebate retention and pharmacy ownership with an aligned, transparent business model focused on the lowest net cost and overall value for our clients.
While some pharmacy benefit managers (PBMs) have been talking about transparency for years, it has become an increasingly hot topic in the health care industry. So what does transparency really mean? Let’s take a fast five (minutes) to look at PBM pricing models and how transparency comes into play.
Everyone is hearing a lot about prescription drug pricing lately thanks to a very famous billionaire entrepreneur. What is cost-plus pricing? Is it new? How is it disrupting the industry? In this Fast Five, we share answers to these questions and provide guidance on how to evaluate this model. For a smart insider’s perspective, we consulted with Sharon Faust, Senior Vice President, Lumicera Specialty Pharmacy.
Making a pharmacy benefit manager (PBM) transition can be a daunting task especially for busy benefit teams. We consulted our internal implementation experts on what a smooth transition looks like and how the right partner will provide reassurance that you are making the right move.
Biosimilars are a hot topic in the pharmacy industry right now. Wondering what all the buzz is about? In this Fast Five, we asked our clinical experts, Janelle Sheen and Imke Scheepers, to share the basics about biosimilars as well as some key insights on this topic.
Our Vice President of Sales, Jonathan Har-Even, shares his outlook on the industry and where we need to go next. He discusses 5 ways the PBM industry can continue to improve and promote better healthcare for all, including a 5-year plan that uses lowest net cost as a foundation and builds out a platform for payors, members, and pharmacists.
Check out this insightful article published in JMCP on these challenges and the implications for plan sponsors working for a sustainable drug benefit.
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