Pharmacy Benefit Management (PBM)
Prescription drug coverage is a necessary part of every benefit package and prescription drug costs account for a large percentage of a plan's claim costs. PBA offers prescription plans through different PBM vendors including mail order pharmacies. Our PBM vendors offer mobile apps that feature cost comparison tools to help drive employees towards lower cost alternatives like mail order or generics.
PBA engages an independent PBM consultant to provide feedback on PBM contracts allowing our clients the opportunity to discuss their contract language and terms with the PBM to achieve better Rx cost containment goals.
With pharmacy benefits costing health plans and employers in excess of 20% of total medical spend, closely managing pharmacy programs has never been more important and is a critical component of PBA's pharmacy benefit best practices.
To this end, our independent consultant performs the following actions:
- Conducts annual claims review to ensure PBM contract adherence in the areas of contracted AWP discounts, dispensing fees, and rebates
- Ensures the most cost effective PBM is in place for each client
- Renegotiates contract terms and pricing as opportunities arise
- Provides insight into PBM trends and programs to ensure clients have the right management techniques in place