How Health Insurers Are Forcing Employers to Use the Insurers’ Pharmacy Benefit Management Service

The money-driven world we live in can often leave us feeling cheated by the very entities we rely on. That doesn’t have to be the case with your pharmacy benefits plan. Recently, Bloomberg news featured a story on how we helped our client Wagstaff, Inc., a small employer group, gain control over their pharmacy plan. They detail their experience carving-out pharmacy benefits from their medical insurance carrier and the extent that insurers are going to keep their clients from unbundling their benefit arrangements.

Excerpt from the Bloomberg Law article:

Wagstaff Inc., a 500-employee manufacturing company in Spokane Valley, Wash., switched from using Premera Blue Cross as its health plan administrator to UnitedHealthcare for its 2019-2020 plan year, Wade Larson, director of human resources, said in an interview.

The switch allowed Wagstaff to contract with an independent pharmacy benefit manager, RxBenefits Inc., which enabled the company to develop strategies for controlling pharmacy costs, especially high-cost specialty pharmaceuticals, he said.

“The specialty drugs are killing us all,” Larson said.

In previous years, Wagstaff experienced double-digit increases, with pharmaceutical costs a major contributor, Larson said. The company expects to reduce its pharmacy spending from $957,000 under Premera, which used Express Scripts, to $754,000 in the 2019-2020 plan year using RxBenefits, he said.

Keeping pharmacy benefits as part of Premera’s plan made it harder for the company to know how much it was spending on pharmaceuticals and how much on medical claims, he said.

“I could not get the best drug deals, I could not negotiate anything different, I couldn’t go shopping, and it was very restrictive,” Larson said of Premera’s drug benefit.

Under its current pharmacy arrangement, the company has the ability to negotiate prices for both generic and specialty drugs and change its benefit design, Larson said.

 Read the full article here: Insurers Move to Blunt Employers’ Use of Alternate Drug Plans

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