Playbook developed to equip purchasers to tackle flawed contracting models and lack of competition due to market consolidation
WASHINGTON, June 26, 2023 /PRNewswire/ — High prescription drug costs continue to bankrupt families, put financial strain on businesses, and drag down the US economy and pharmacy benefit management plays a significant behind-the-scenes role. To arm employers and other plan sponsors with a blueprint to understand and navigate PBM relationships and strengthen their negotiating and contracting capabilities, the National Alliance of Healthcare Purchaser Coalitions (National Alliance) developed A Playbook for Employers – Addressing Pharmacy Benefit Management Misalignment.
“As fiduciaries, employers have a responsibility to challenge industry misalignment and self-dealing, and this playbook offers strategies to contract for and build a more trustworthy, responsible and sustainable marketplace,” said Michael Thompson, National Alliance president and CEO. “With health plans and PBMs increasingly owning each other and the growing side deal payment arrangements to consultants and brokers, this is a classic case of the ‘fox guarding the henhouse’.”
The comprehensive resource examines the role of the fiduciary in pharmacy benefit management and offers insights on the drivers of pharmacy benefit costs and value, and flaws in the contracting and negotiation process. Purchasers also have access to best practice checklists, sample questionnaires for selecting consultants and recommended contracting language that would typically require an investment of thousands of dollars to obtain from their legal counsel.
The top 10 pharmacy benefit management concerns identified by an industry advisory committee and purchasers working with the National Alliance for this initiative are:
- Promotion of higher-price drugs when lower-price drugs are available.
- Coverage and/or preference of a brand when a generic or biosimilar is available.
- Coverage of specialty drugs for…