The future of pharmacy benefits isn’t transparency. It’s access.
For years, pharmacy benefit reform has centered on transparency. Employers have pushed for greater visibility into drug pricing, rebates, and the economics behind their pharmacy benefits.
That progress matters. But is the prescription drug market changing faster than the traditional benefit model?
In a new opinion piece for BenefitsPRO, Prescryptive’s SVP of Payer Solutions, Raechele McMahan, offers the insight that the next challenge for employers isn’t simply understanding how medications are priced. It’s ensuring employees can access the right medication through the most efficient and affordable pathway available.
The ways patients can access medications are multiplying, from traditional pharmacy benefits and manufacturer-sponsored programs to cash-pay pricing, direct purchasing arrangements, and new digital channels. That changes the question employers need to ask.
Instead of evaluating pharmacy strategy primarily through formulary placement, rebate guarantees, and network performance, employers increasingly need to understand all of the options available to an employee at the moment they need a medication.
- Is the benefit price the best price?
- Is a manufacturer program available?
- Is there a more affordable cash option?
- Could a direct arrangement provide better value?
- And, importantly, can the employee actually see and act on those choices?
Those aren’t just transparency questions. They’re access questions.
And they point toward a larger shift in the prescription drug market: from managing access through a limited set of predetermined pathways to creating a marketplace in which patients can connect to the right product, price, and pharmacy.
The objective isn’t to eliminate benefit management; a direct access marketplace can bring traditional benefit coverage together with manufacturer programs, cash-pay pricing, coupons, and direct employer arrangements. The goal of better market design is to give employers and employees access to the broadest set of clinically appropriate and economically efficient options.
Transparency tells employers what happened. Access expands what is possible.
The next generation of pharmacy benefits should do more than make the existing system easier to see. It should help people navigate a growing marketplace of access opportunities, and connect each person to the right medication, at the right price, through the right channel.