The New Goal for PBMs: Transparency Opaqueness may be on the way out

In a bid to provide greater disclosure, some large companies have sought alternatives such as forming alliances as a way to purchase prescription drugs, bypassing the traditional PBM model. Others have turned to PBMs where revenue is  generated through a disclosed and fixed fee per member per month, or a per-claim administrative fee.

Pharmacy benefit administrators (PBAs), are also increasing in popularity. PBAs manage administrative services for the plan sponsor, including claims processing and data reporting.

Derek Daggett, Senior Sales Executive for San Francisco-based PBM SmithRx, told Drug Topics that he’s been seeing an increase in the number of transparent PBMs.

“Within the last five years, transparent PBMs have gone from being an outlier in the industry to now representing 40% of contracts,” he said. He added that the number of truly transparent contracts (meaning full disclosure of network contracts, no spread, and full pass through of rebates) is comparatively low.

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December 12, 2017