A pharmacy benefits management (PBM) audit can help trim drug spending

For most U.S. businesses, prescription drug spend is on a runaway train. From a new specialty drug to the one your employee has been taking for years, the average patient cost for brand prescriptions filled through a commercial insurance plan has increased more than 25 percent since 2010, reaching almost $50 per prescription. Total annual U.S. prescription drug spend is expected to increase at a rate of at least four to seven percent annually.1

Reviewing your company’s pharmacy-benefit-management (PBM) contract may be the cure. Oftentimes, the PBM is the least analyzed component of a business’ healthcare benefits. That’s because you likely negotiated a contract years ago and haven’t taken a second look since.

Time to revisit pharma spend

To help employers ensure they have the best PBM contract terms, HUB International provides complimentary contract reviews to clients. The opportunity to improve the contract terms that drive an employer’s pharmacy costs is significant. This PBM audit can save employers anywhere from 6% to 35% on their general and specialty drugs through optimized pricing or a complete PBM contract re-negotiation.

How do you know if you can benefit?

Ask yourself the following questions when conducting a PBM audit to determine your savings potential:

  1. Do I know the terms of my current contract and, if so, are they optimal in today’s market? (NOTE: If your medical carrier is managing your pharmacy benefits, you may not know your specific contract terms. And if you haven’t negotiated the terms, then significant savings are possible.)
  2. Do I have a PBM contract that guarantees pricing terms and rebates? Is it auditable, with a recovery process for any shortfall in performance?
  3. Am I confident that specialty drugs, like those for Hepatitis C, are being properly priced and managed by my current provider?

If you answered ‘no’ to any of these questions, or you haven’t reviewed your PBM contract in the last 12 to 18 months, auditing your pharmacy spend to determine if it’s performing properly will be key to future savings.

Contact your HUB employee benefits team to find out how your business can review and re-negotiate your pharmacy benefits contract.

1. 2016 QuintilesIMS Institute Health Study: Medicines Use and Spending in the U.S.: A Review of 2015 and Outlook to 2020