OPINION: Rethinking Prescription Drug Costs–A Strategic Approach for Businesses

Prescription drug costs are rising, and businesses and their employees are feeling the pinch more than ever. High-profile solutions from companies like GoodRx, Mark Cuban Cost Plus Drugs, and Amazon Pharmacy are capturing headlines and offering the promise of relief. While these innovations are welcome, they may differ from the panacea they’re perceived to be for group health plans. Before businesses adopt these new services, a strategic reassessment of existing systems is advised, potentially revealing that the best solutions are already within reach.

Get Experienced Advice Before You Leap

In the face of rising healthcare costs, the allure of implementing quick healthcare innovation is strong, but group plans should proceed cautiously. An invaluable first step is consulting with your broker to determine if your current plan is optimized for cost-effectiveness. It is critical to have a broker who genuinely champions your company’s cost sustainability and their employee’s health interests.

A company’s Employee Benefit Broker is a crucial yet often overlooked player in managing healthcare costs. Far from mere intermediaries, these insurance brokers serve as advocates for their clients, wielding influence over Pharmacy Benefit Managers (PBMs)—the entities tasked with managing drug benefits.

As such, the choice of broker can be as impactful as the choice of healthcare plan. They should be your navigators in a complex sea of options, guiding you toward the most effective and efficient solutions tailored to your needs. Thus, selecting a broker that not only represents a diverse range of carriers and PBMs but also remains committed to transparency and consistently prioritizes cost savings and efficiency is imperative. In a constantly evolving healthcare landscape, a strategic alliance with a true partner broker is no less than a necessity.

How Brokers Can Make a Difference

1. Ensuring Transparency: Brokers should work to secure clear and transparent contracts and agreements with PBMs, unraveling the often-convoluted pricing and rebate schemes that can obscure the true cost of drugs.
2. Championing Affordability: Brokers can scrutinize drug formularies and advocate for access to cost-effective medications, challenging PBMs to prioritize value over rebate incentives.
3. Highlighting Alternatives: Brokers can be adept at identifying innovative strategies beyond the standard PBM model, such as self-funded pharmacy benefits or direct partnerships, fostering competitive environments that benefit the plan.
4. Empowering Employers: Through demystifying the PBM process, brokers can equip businesses with the knowledge to make informed decisions, potentially catalyzing broader industry change.

Consider The Big (3) Picture

Employers seeking effective health benefit solutions for their organization should consider the broader landscape of prescription drug management. The dominance of only three large PBMs, Optum, Caremark, & ESI, known as the ‘Big 3,’ presents challenges, particularly for smaller self-funded groups underserved in the current market. This dominance can lead to limited competition and higher drug costs, especially for smaller employers who may not have the negotiating power of larger companies.

In this landscape, smaller, agile PBMs find their niche, offering tailored and focused services and advocating a more balanced approach to prescription drug management. Employers should begin this journey by consulting with an experienced advisor like their Employee Benefit Broker. These advisors can be invaluable for evaluating smaller PBM options and other healthcare options such as GoodRx, Mark Cuban Cost Plus, etc. By leveraging a benefits advisor’s expertise, businesses can circumvent the challenges posed by dominant PBMs and find tailored solutions that prioritize cost-effectiveness and employee well-being.

A Holistic Approach to Healthcare Solutions

As we continue to confront the complexities of the healthcare system, it’s clear that nuanced solutions are needed. The debate around PBMs and drug pricing is multifaceted, reflecting broader systemic issues. Some ideas seem like efficient fixes when employers are concerned about rising drug costs; however, carefully forming strategic partnerships may benefit their organizations and employees in the long run. By working with the right brokers, advisors and PBMs, businesses can take important steps to address these challenges, ensuring access to affordable medications and providing a fair and transparent healthcare environment.