Growing concerns about the affordability of needed drugs and the increasing number of prescriptions being filled may be causing you to ask if your Pharmacy Benefit Plan is appropriately designed. Equally important is whether your Pharmacy Benefit Manager (PBM) is providing the level of service your employees need, and whether the pricing schedule you have is competitive. Pharmacy benefit plans come in many different forms and one size does not fit all. Whether it’s only a ‘discount card’ plan or a traditional design that offers fixed dollar co-pays for generics and name brand drugs, the plan should be designed using a strategy with your objectives in mind. There are many different design features being used today. For example, many plans are designed with cost-shifting techniques like percentage co-pays that stay proportional to increased costs. Others are incorporating three or more co-pay tiers that allow the employer to differentiate lifestyle uses and specialty drugs. Multiple tiering often permits the added opportunity to obtain deeper discounts in exchange for allowing PBMs to steer utilization to medicines that are on their preferred, or formulary drug list. When evaluating a PBM proposal, discounts off of AWP (average wholesale price) and MAC (maximum allowable charge) pricing typically draw most of the focus. However, the PBM’s respective dispensing fees, administration charges and rebate allowances can go a long way to off-set a point or more in discounts. If you haven’t reviewed your pharmacy benefit plan in a while, now might be a good time to take a look at the options available to you.

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