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Why Should Self Funding Organizations use PBMs?

December 18, 2017 | John Preville

One of the most sought-after services that we offer at Varipro is a Pharmacy Benefits Manager. What we often hear from employers who have recently decided to self-insure is, “why should I hire a PBM?”. So, in this week’s article, we have chosen to highlight the reasons why PBMs make a fantastic asset for self-funded organizations.

What is a Pharmacy Benefits Manager?

A PBM (Pharmacy Benefits Manager) is a TPA who provides managing services for the prescription drug coverage portion of a self-insured employee benefits program. PBMs are the primary point of contact between the self-funding organization and their pharmacy and oversee every aspect of that program.

Why Hire a PBM?

  1. Pricing and Costs

One of the primary objectives for PBMs is to keep the cost of providing prescription drug coverage low. To do so, they use their strong relationships with pharmacies and pharmaceutical reps, along with their industry insight and knowledge to negotiate pricing for prescription drugs. By doing this they not only ensure pharmacies are not overcharging, but they also fight for lower than “off-the-shelf” pricing, keeping costs low for employers and employees.

  1. Administration

PBMs also oversee all of the communication for and delivery of prescriptions. They are the first and last point of contact, from having prescriptions filled to ensuring delivery to patients. Creating less hassle for employees who are in need of continuous prescriptions due to chronic or long-term illness.

  1. Patient Compliance

By hiring PBMs, employers also ensure that their employees who make use of prescription coverages are compliant, based on rules and regulations. Now, PBMs are not on site personally testing employees. They’re keeping a watchful eye on patient activity, looking out for dangerous patterns or irregularities.

  1. Ensure Quality

Last, and what we consider to be most important, is the overwatch of your entire prescription program. By having eyes on every aspect of this program, PBMs can ensure that pharmaceutical companies are providing quality care and products.

By enlisting the services of a PBM you’re giving yourself peace of mind, ensuring that every aspect of your pharmacy benefits program is running correctly. You’ll also make life easier for your employees, especially those who battle chronic or long-term illness. Most importantly, you make your prescription drug program as affordable as possible, while providing high-quality service. To learn more about Pharmacy Benefits Managers, check out our smartsheet: What is a Pharmacy Benefits Manager