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MedBen Fights Back Against PBM Spread Pricing

10/07/18

  09:25:00 pm, by MedBen5   , 348 words,  
Categories: Cost savings, Pharmacy benefit manager (PBM), MedBen Rx, MedBen Rx Advocate, MedBen Rx Alliance

MedBen Fights Back Against PBM Spread Pricing

drugs

Spread pricing is a little-discussed aspect of prescription drug pricing, but its impact on pharmacy plan costs can be huge… and it’s why MedBen has responded with new pharmacy programs designed to remove spread pricing from the cost equation altogether.

Simply stated, spread pricing represents the difference in the amount a pharmacy benefits manager (PBM) reimburses pharmacies for a drug and the amount they charge their clients, such as employer health plans. In some cases, that difference can be substantial.

A recent Bloomberg.com article provides a revealing glimpse into the effect that spread pricing has on pharmacy plan costs – particularly generic drugs, which represent almost 90 percent of all prescriptions dispensed in the U.S. "Among the generic drugs examined, pharmacies and [PBMs] on average added to the bill almost 32 percent in 2017," the article notes.

In a review of 90 of the best-selling generic drugs used by Medicaid managed-care plans, Bloomberg found the biggest markups tend to come on new generics, such as a leukemia pill in which they found spread exceeding $3,000 per prescription (see chart).

drug spread pricing sample

PBMs counter that higher spread pricing on some drugs offset money lost on others… but for clients dealing with ever-rising prescription prices, such explanations ring hollow.

When MedBen revamped its pharmacy plan design last year, we concluded that the best way to control spread pricing was to eliminate the temptation altogether. To that end, we introduced MedBen Rx Advocate, a program that avoids spread pricing by paying the average cost pharmacies pay for a drug, plus an appropriate dispensing fee. For the client, it means a fair price and no artificial mark-ups.

Alternately, qualified employers can take advantage of our new MedBen Rx Alliance program, which uses the purchasing power of hospitals to offer reduced drug prices in conjunction with local pharmacies. Again, spread pricing is taken out of the cost calculation.

MedBen helps you keep your Rx plan costs as low as possible, and removing spread pricing is just one way we do it. Learn about how our pharmacy solutions work by contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com or (888) 627-8683.

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