As options for pharmacy benefit managers (PBMs) expand, focusing on
Calls for
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While it's tough to bring in a benefit that pleases every employee, asking the right questions, developing a better understanding of
"Leaders [need] to have enough information during the process of selecting a PBM, or setting up their benefit plan, to make a reasonable, prudent decision at the time based upon the information they have in front of them," he says. "It doesn't have to be perfect, but it has to be rational or reasonable."
Gathering good information
By knowing what questions to ask potential PBMs, benefit leaders can make better decisions. Fiorini suggests inquiring about how they price their drugs and where it makes its money, checking to make sure profit isn't derived from pushing high-cost medicines and that prices are competitive and consistent.
"For you to have a better idea of how you get a better benefit and administration of your benefit, you have to understand where everyone's making their money and where their incentives otherwise lie," he says.
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Leaders should also ask about the level of customer service employees will receive — part of what determines whether what is being charged is reasonable for the services provided, Fiorini says.
He emphasizes the need for benefit leaders to familiarize themselves with generic drug options so that they come prepared for conversations with PBMs, and so they can pass this knowledge on to employees. Becoming more knowledgeable means a much better chance of finding a PBM partner that is aligned with a company's overall benefit goals.
"It's going to pay off, because you're going to create the construct of how your PBM provides services to your membership, and it's going to be consistent with your priorities [for your] benefit plan," Fiorini says.
Selecting third-party support
Tapping an experienced broker or legal adviser can help benefit managers with everything from basic questions to compliance details, but again, selecting the right one is key. Just as he did with PBMs, Fiorini suggests asking potential consultants and brokers how they are compensated, and looking elsewhere if they turn out to be incentivized by a healthcare company to push clients toward their services.
"The consultant has to disclose all direct and indirect compensation they may otherwise make related to your benefit plan," he says. "Some consultants have arrangements with the big PBMs to move people into their coalitions, and they get paid [for this], so you have to [find] that out."
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Legal advice is another valuable avenue of support, specifically experts on ERISA, Fiorini says. All of these steps enable leaders to help their organizations provide the best coverage and avoid blowback from employees, like the pending lawsuit against JP Morgan in which current and former employees allege mismanagement of their prescription medication benefits.
To solidify an employee-centric choice, Fiorini advises leaders to enlist an independent committee, separate from the organization, to evaluate a potential PBM and determine its selection is in the best interest of its workers. Bringing in a partner that saves people money, offers access to necessary medication and provides a high level of customer service can make a profound difference for them both in and out of the workplace.
"People are looking for something different," Fiorini says. "If I want to have a healthy and productive workforce, I would try to make sure that the benefit truly reflects how I can improve people's lives," he says.
Read more about pharmacy benefits and transitioning to a new PBM:
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