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It is often stated that understanding prescription benefits — and pharmacy benefits management contracting — is difficult, but the opposite is in fact true.
What confounds many organizations and industry professionals are the various subjective elements and concepts that are considered standard. Among these are average wholesale price (AWP) discounts for generic drugs, 100% pass-through for rebates and the essential claim of transparency.
Terrance Killilea, Pharm.D., is SVP Clinical/Fiscal Integration at USI Insurance Services.
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A financial spreadsheet alone cannot capture the total value and performance of a benefits program, nor can numbers on a ledger guarantee long-term operational success.
Bringing a procurement partner into the benefits planning process can offer greater insight and negotiation power, helping to reduce overall costs.
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.
Brokers are urged to read the fine print on stop-loss contracts to ensure adequate coverage is in place, and have clients pool risk whenever necessary.
