Pharmacy Benefits Management (PBM)

 

What is PBM?

A pharmacy benefit manager is a third-party administrator of prescription drug programs. The American Pharmacists Association states that “PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers and processing and paying prescription drug claims.” The value of an effective PBM lies in its ability to manage the cost and utilization of prescription drugs for the plan sponsor. 

The cost of pharmacy benefits continues to rise for our clients and the industry. Drug spend for employers is 18%-25% of all medical/Rx spend combined, and this is expected to double by 2020. If a medical plan is fully insured, the pharmacy spend is considered “carved in,” and thus, the responsibility of managing the PBM falls to the plan sponsor. If a client is self-insured, the pharmacy spend can then be “carved out.” Carving out the pharmacy spend allows the employer to choose their PBM, demand accountability and define the contractual terms of the PBM contract. 

MSW PBM Brokerage & Consulting Services

MSW provides PBM brokerage and consulting services to assist our clients in managing the full pharmacy benefits lifecycle. Through our brokerage and consulting services, our clients experience:
  • Optimized financial results
  • Up-to-date market contract language
  • Improved fraud, waste and abuse programs
  • Better integration with medical and disease management programs
  • Increased levels of satisfaction with their PBM relationships
  • PBM integration with onsite/near-site clinics (if applicable)
MSW provides a full PBM program assessment for our clients, and collectively, we’ve generated 8%-16% in client savings per PBM contract reviewed. For more information related to our PBM practice, please click on the links below.