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This is the second in a two-part series on the complexities of pharmacy benefit management.
A pharmacy benefit manager can be a powerful ally for insurers in the war against high drug costs. Having a quality PBM in place is half the battle. Making sure the PBM performs as needed is essential. Both federal and state governments are currently working on ways to rein in spiraling drug costs, but for now, knowledge and information are key.
Barbara Tomlin is the Barbara director of the ROSE Program and U.S. Group Re Rose/Rosebud.
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As healthcare expenses approach double-digit increases, employers are looking for savings in waste, care delivery, and plan administration before cutting benefits.
Bringing a procurement partner into the benefits planning process can offer greater insight and negotiation power, helping to reduce overall costs.
Gap coverage, supplemental benefits and options for various types of workers can help avoid cost shifting and still provide support.
The legislation calls on Congress to lower prescription drug costs, shift subsidies directly to consumers, and enforce strict price transparency.
Employers are under pressure to keep benefits competitive while controlling costs, driving new scrutiny of PBMs, hospital prices and GLP-1 coverage for 2027.
