Rising drug costs, lack of transparency, and poor support are prompting many plan sponsors to seek new pharmacy benefit management (PBM) solutions that truly deliver on their promises…
More than a decade ago, an estimated 30% of U.S. healthcare spending—approximately $750 billion—was wasted on unnecessary services, excessive administrative costs, and fraud…
Pharmacy benefit audits are essential to maintaining the integrity and value of benefit plans. They play a crucial role in holding pharmacy benefit managers (PBMs) accountable…
National CooperativeRx’s pledge to our members is to ensure quality pharmacy benefit programs, plans, and service. Thus, we are constantly looking for opportunities to add value…
Staying informed about the latest drug trends is essential for optimizing pharmacy benefit plans. At National CooperativeRx, we monitor…
Most payers can expect the percentage of member cost share to decrease over time. This is because most plans use fixed or flat copays…
The 340B Drug Pricing Program was established to help healthcare entities offer affordable medications to underserved populations. However, its expansion over time has led to challenges…
While these purchasing models share a common goal—aggregating the buying power of individual plan sponsors to lower pharmacy benefit costs—their structural differences in governance, pricing, and accountability significantly impact…
Expect another year of non-specialty drugs surpassing specialty drugs in their overall contributions to trend. GLP-1s will continue to be major drivers.
Offering rebates has been a pricing strategy for manufacturers of brand-named prescription drugs for decades. The explosion of rebate value has happened over the last 10-12 years as pharmacy benefit managers (PBMs)
In this final part of the series, we will dive into PBM performance and support—answering questions about how PBMs gauge plan effectiveness and provide support to stakeholders.
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.