Minimizing Pharmacy Plan Costs with Lisa Stamm
Lisa Stamm, VP of Consulting Services at Sherril Morgan discusses minimizing pharmacy plan costs. She explains how the pharmaceutical industry is one of the most complex and expensive costs for companies that sponsor health plans, specifically determining how much is being paid toward pharmacy benefit management.
Pharmacy Benefit Managers (PBM) main role is to facilitate transactions when a member fills their prescriptions at a pharmacy. There are four traditional ways of how a PBM is compensated. The first is spread, which is adding a cost to every prescription they process; with this cost being built into the pricing makes it difficult to quantify for the employer. The second is Rebate Retention, this is retaining all the rebates that plans get when members use their prescription drugs, instead of hitting the employer's plan. The third way is by obtaining the part of the co-pay that was higher than the cost of the prescription, and the fourth is in a traditional structure by being a part of the mail order process. Each time someone uses mail order the PBM is obtaining revenue from the transaction.
She shares the problems of a traditional model and the benefits of Pass Through as an alternative, which is when a PBM is given a fixed and controlled administrative fee.
She also explains how focused an employer should be on pharmacy rebates, mail-order and the co-pay structure’s best strategy to prescription drugs management
