PBM Transparency

Transparency helps the insurance market work better. It allows plan sponsors and payers, including employers and governments, to confirm that a PBM is providing the service it was hired to do: to lower drug costs.

"As much as 5% of prescription drug spending is retained by PBMs."—Congressional testimony of Susan A. Hayes, Pharmacy Outcome Specialists, June 24, 2009

Without transparency there is no way to verify a PBM is sharing manufacturer rebates, the amounts of those rebates or that the PBM is negotiating the lowest possible costs for specific drugs.

Current proven savings:

• Texas estimates savings of $265 million by switching to a transparent PBM contract for state employee drug coverage.
• The University of Michigan saved nearly $55 million by administering its own plan.
• TRICARE anticipates savings of $1.67 billion by negotiating its own drug prices and rebates for its 9 million beneficiaries rather than going through a PBM.

FOR MORE SEE

Clarity: Top 10 Ways Secretive PBM Practices Drive Up Health Care Costs

• Presentation PPT (962k)

Demonstrated Savings from PBM Transparency Appendix A

10 Questions Company Benefits Managers Must Ask Their PBM PDF (1M)