A checklist of what to look for in a pharmacy benefit expense manager.
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The new breed of PBMs, and their hybrid pharmacy benefit administrator (PBA) counterparts, boast that they are unlike the well-known, mega-PBMs who they posit as the “old guard”. In fact, upon close examination, many of the newly-minted PBMs are nothing other than watered-down versions of the big players, albeit a little more honest.
PNPS offers a genuinely new approach toward pharmacy benefit expense management. As a means by which to compare our proposal, we provide the following list of the key ingredients we believe are necessary to structure an efficient, patient-oriented, cost-effective and fully ERISA-compliant offering:
-- A truly transparent, full disclosure and pass through pricing structure,
-- A pharmaceutical cost structure based on net acquisition cost,
-- The ability to deal directly with the pharmaceutical manufacturers,
-- An expansive network of retail pharmacies, including sub-networks,
-- Multiple large-scale redundant independent mail-order and specialty pharmacies,
-- Proven, flexible technology that supports complex coverage rules and utilization controls,
-- Access by all remote users to the technology platform via the Internet,
-- The creation of a formulary that is value-based, not profit oriented,
-- Plan designs that encourage the best result for the patient (not the PBM),
-- An independent Pharmacy & Therapeutics Committee that acts in the sole interest of patients,
-- Full support in the management of clinical initiatives for patients, providers and pharmacies,
-- The ability to support integrated medical and pharmacy claims processing,
-- Advanced online tools to support patient decision-making,
-- A call center for HR directors, patients, physicians and pharmacists staffed with highly-
trained personnel that act only on their behalf, and
-- Independent outside program oversight to ensure program integrity.
We welcome the opportunity to discuss each of these attributes with you.
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