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Pharmacy claims continue to make up a large portion of the overall dollars spent by employers in their medical programs, often in excess of 20%. Too often the pharmacy benefit manager (PBM) is not analyzed properly to ensure you are receiving not only the best possible pricing, but also the best leverage of pharmacy data for disease management purposes. Anyone who has spent much time evaluating PBMs knows that there is often very little transparency in regards to where your money actually goes; especially with respect to rebates.
We believe your first goal should be to ensure you have the best possible prescription drug pricing in the market, and to push towards as much transparency as possible. Then once you have the best pricing, it is critical that you use the data gathered in your overall population health management efforts.
The 340B drug pricing program offers a great opportunity to qualified disproportionate share hospitals. There are also many other organizations potentially eligible, such as federally qualified health centers. If you fall into this category of eligibility, you could be eligible for significant savings on your prescription drug costs.
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