Most PBM partnerships are fraught with conflicts of interest, the plan is misdirected and the goals of the employer and PBM are out of alignment. PBMs often keep hidden revenue streams that should be returned to the plan sponsor and intentionally make it difficult to see how they are really making their money.
The chart below indicates the revenue sources for the typical traditional PBM arrangement. It is important to note that only 10% is fully disclosed or negotiated with the employer. All other sources are taken without their knowledge.
Traditional PBMs try to sell value through low administrative fees, high pharmacy discounts, low dispensing fees and artificially inflated rebate payments. But additional pharmacy discounts, hidden mark-up or “spread” pricing, rebate earnings, and other pharmaceutical incentives may not be completely disclosed; leaving you guessing as to the real cost of your plan.
Our transparent pass-through model focuses on helping clients understand the industry and manage drug spending. The complexity of the traditional model vanishes and a productive partnership is the net result.
Since the inception of our PBM Solutions, DataRx has endeavored to change the buying habits of the pharmacy benefits management industry. Historically, PBMs were selected by comparisons that only evaluated a few components such as the administration fee, AWP discounts, dispensing fees and rebates, but these discounts and fees only represent a small portion of the total drug spend and are often misrepresented or manipulated. What matters most is the cost of each therapeutic category and the drugs that are actually being used. By focusing on the drug mix and costs by therapeutic class, we can help you maintain the lowest drug cost.
At DataRx our PBM Solutions provide value in competitive pricing strategies, focus on the appropriate drug mix, and rebates where and when they make sense. Our fully transparent pharmacy benefits model is fully aligned with the customer’s goals and objectives. We have eliminated the hidden mark-up or “spread” and do not retain rebates, network discounts, or incentives. Our sole motivation is to maximize generic savings opportunities, select the lowest net cost brands in the formulary decision process, and implement other cost reduction strategies.