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Pharmacy Benefits 101: What Employers Need to Know About PBMs and Drug Spend

UPDATED ON
October 27, 2022
Abbey Dean
Abbey Dean
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Employers across the country are rethinking how employee benefits can be used to attract and retain a talented workforce, while simultaneously weighing how best to control benefits spend–often an employers’ second biggest line item–amid record inflation and increasing costs.

So, how can employers maximize benefits to attract talent while balancing costs and external forces like inflation? An excellent place to explore is pharmacy. In fact, pharmacy is the only negotiable benefit on a per unit basis, and at up to 30% of healthcare expenditure, it is an area where making an impact can provide better benefits and better control of costs.  

Unfortunately, the space is also complicated, ever-changing, and full of complex programs that are challenging to untangle. For this webinar, Mployer Advisor teamed up with our friends at Truveris, an expert in the realm of pharmacy benefits and pharmacy benefit managers (PBMs).

Truveris is a healthcare technology company focused on increasing access and affordability for prescription benefits. As an objective third-party platform specializing in pharmacy, their team helps employers get the best contract and the best pricing, with oversight, to support your program throughout the pharmacy benefit lifecycle.

Ryan Storey, the VP of Pharmacy Solutions and Strategic Accounts at Truveris co-presented the webinar alongside Anthony Water, Mployer Advisor’s Senior Vice President of Strategy and Product.  During the webinar, Storey explained the role of PBMs, employer challenges and opportunities in the pharmacy benefits space, and how addressed common questions around pharmacy benefits and how to mitigate rising costs and optimize value.  

In his section, Waters explained to attendees how to assess the competitiveness of their benefits plan, specifically focusing on plan design, voluntary benefits, and medical cost sharing.  

Below are a few highlights from the webinar event.

What Is a Pharmacy Benefit Manager?

Pharmacy benefit managers (PBMs) are responsible for administering and managing prescription drug benefits for employers and health insurance companies.  

To be clear, PBMs are not insurance companies; PBMs negotiate discounts with drug manufacturers and pharmacies. A PBM’s primary goal is to lower the cost of prescription medications and improve affordable access to quality prescription drug care.  

Typical PBM services include the following:

  • Claim adjudication
  • Drug formulary
  • Retail networks
  • Home delivery
  • Specialty drug management  
  • Drug utilization review  

Controlling the Controllables in Pharmacy  

During the webinar, Storey underscored the importance of controlling the controllables in pharmacy from procurement, to oversight, then finally optimization. Storey explained the ability to optimize a pharmacy program is directly impacted by five factors:

  • The timing of procurement
  • Introducing optionality into the process
  • Creating dynamic competition
  • Independent oversight
  • Member engagement transparency tools

When asked what achieving transparency in pharmacy looks like Storey explained that transparency is simply about being about to control your pharmacy program, with the knowledge that you are receiving the best price, contact, and oversight. Storey added that visibility into the discrete components and cost drivers of a pharmacy program was vital, too.

Watch the On-Demand Webinar Now    

For more in-depth information, tune in to watch the complete on-demand webinar, “Pharmacy 101 Benefits: What Employers Need to Know About PBMs and Drug Spend.”  

To learn more about Truveris and explore their library of resources, click here.  

If you haven’t yet, be sure to scroll through Mployer Advisor’s past webinars by searching through our library of on-demand content.    


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