In this second part of our series, we delve into the inner workings of PBMs, answering questions about what happens after a patient fills a prescription, how benefits are effectively managed, and the strategic approaches PBMs utilize.
Employer groups often engage brokers, consultants, or third-party administrators to assist in evaluating and selecting pharmacy benefit plans to offer their plan participants. While these professionals handle much of the detailed work
National CooperativeRx’s member-owned, not-for-profit cooperative model provides additional financial benefits for members. This includes 100% pass-through of rebate true-up, retired equity, and excess revenue in the form of patronage dividends.
Industry reports have shown the percentage of healthcare dollars spent on pharmacy continues to rise, jumping from 21% to 27% since 2021.¹ With even greater trends projected in the coming years,
Plan sponsors and their partners lean on their pharmacy benefit manager (PBM) to facilitate the implementation process. However, some PBMs have better processes than others. That is why working with a trusted PBM is crucial.
Over the last several years, there has been a lot of anti-PBM press and hundreds of state and federal legislative proposals to reform PBMs.
