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Guard Against PBM Tactics, Warns Rx Expert

03/22/13

  11:43:08 am, by MedBen5   , 276 words,  
Categories: News, Prescription, Health Plan Management

Guard Against PBM Tactics, Warns Rx Expert

Presenters at MedBen Universities in 2013 will include members of the MedBen team speaking on a variety of benefits management topics. But we also invite outside health care professionals to share their knowledge. One such featured speaker at many MBUs and roundtables is Allan Zaenger, President of Pharmaceutical Horizons, a pharmacy plan consulting service.

Allan Zaenger, President of Pharmaceutical Horizons

At MedBen’s recent hospital and government roundtables, pharmacy benefits expert Allan Zaenger examined the methods some pharmacy benefit managers (PBMs) use to secure their own profitability, such as margin manipulation and rebates, while leaving their clients with reduced financial returns.

“Not all PBM discounts are equal", Zanger said, noting that contracts a PBM makes with with a retail pharmacy can differ greatly from a contract a PBM makes with a health plan sponsor. For example, a PBM may arrange a 70% discount on generic drugs from a pharmacy, but only a 65% discount for the plan – and keep the difference.

Zaenger also warned about “rebate distortion", a practice in which member copays do not align properly with preferred brand drug formularies. “If you try to maximize rebates based on the PBM’s recommendation, you may actually increase costs in that drug category,” he said

To guard against such tactics, Zanger also offered plan design strategies. “Monitor any claims you receive from pharmacies that may have contracted for higher reimbursement from the PBM,” he advised, “and restrict member access to those pharmacies.” By doing so, employers could reduce their “Amount Paid” costs by 2-5%.

Allan is among the speakers scheduled to appear at future MBUS. For additional information about upcoming events, check the MedBen Blog or e-mail MedBen Sales Analyst Sally Wood at swood@medben.com.

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