Pharmacy benefits: 3 questions to ask to reduce plan costs


By David McKay
Deputy General Counsel
Prescryptive Health

Manufacturer rebates play a major cost-saving role in a well-designed pharmacy benefits plan. But too much focus on driving those rebates can distract from the bigger goal: Reducing overall net plan costs.

A plan that bolsters your bottom line and provides the prescription benefits members want and need requires a balanced review of plan design, rebate transparency, and overall cost. But how do you shift the attention typically given to rebate savings and put the spotlight on reducing net plan costs?

By asking questions that change the conversation.

Here are three critical questions to ask about your plan. The answers can help lead you down a path to bigger savings and a better member experience. (And maybe even help you find a better PBM.)

Which medicines on your formulary are driving plan costs?

This question helps uncover if the PBM is driving medication utilization toward the most cost-effective solutions or those with the highest rebates. Many medications have similar high-quality, clinically effective, nearly identical equivalents available at lower costs.

Which medications are driving rebates?

PBMs often place drugs on a lower tier of the formulary based on the negotiated rebates from pharma manufacturers. This impacts drug utilization. Is your PBM incentivized to promote higher rebated drugs that end up costing you more?

Are there quality, lower-cost alternatives to these rebate drivers that would be better for plan savings?

As consumers, we should be asking ourselves questions like we would in any retail setting, such as: “Would I rather get $40 back after spending $100 or would I rather pay the full price and have my total expense be $15?”

By taking time to investigate and inquire, you can shift the cost conversation and reach your benefits-spend goals. Your employees, and your bottom line, will appreciate the extra efforts.


Read Prescryptive Health validation reports HERE.