PBM disclosure rules still leave benefits brokers with unanswered questions

The pharmacy market has changed. Has the way we evaluate it? More transparency into pharmacy benefits is a step forward. But transparency alone doesn’t give employers or their employees more control.

In a new Insurance Business article, Prescryptive’s SVP of Payer Solutions, Raechele McMahan, makes the case that the bigger opportunity is to rethink how pharmacy benefits are evaluated as new models emerge.

Traditional evaluation models tend to emphasize rebates and drug discounts. But that can miss important questions: Can employees see what a prescription will actually cost? Can they compare their options? Are financial incentives influencing where prescriptions are filled or which medications are preferred?

Technology can increasingly bring individualized cost and choice information to people when they actually need it, at the point of prescribing. And brokers and consultants have an important role to play in helping employers evaluate a market that looks very different from the one many of today’s models were built to assess.

“We have to help them do their jobs better on how the industry has changed,” as McMahan says in the piece.

That evolution matters. Better pharmacy benefits won’t come from simply making the existing system more visible. They’ll come from creating better ways for employers and consumers to make decisions within it.

Read the full article in Insurance Business.