When it comes to controlling drug costs, having visibility into pricing, discounts, rebates and pharmacy benefit manager (PBM) fees is one thing. Patient outcomes, engagement and actual cost savings over the long term are another.
Some health plans and employer plan sponsors have shifted from traditional to transparent or so-called “pass-through” PBMs.
A key selling point to this new PBM model is—you guessed it—visibility into the actual costs of drugs on the formulary and fees charged for managing the pharmacy benefit. Another attribute, in most cases, is that discounts and rebates negotiated with drug manufacturers pass directly to the health plan or plan sponsor.
Most plans still operate under the traditional arrangement, in which a PBM negotiates prices the plan pays for a manufacturer’s drugs and what the PBM pays pharmacies to dispense them. The difference in those prices (a.k.a. “spread” pricing) is the traditional PBM’s main revenue stream.
Time and results will tell which model the market prefers, but more cost transparency in healthcare is a good thing. However, visibility alone doesn’t guarantee value. The right pharmacy solution can extend and leverage transparency throughout more of the pharmacy benefit, especially for the plan members who use it.
Here are five reasons plans should double down on transparency and the added value transparency alone can’t deliver:
1. Visibility plus action
Seeing the data is one thing—knowing what to do with it is another. A tool like Rx Savings Solutions (RxSS) can turn insights into interventions, helping plans drive smarter decisions and improve member outcomes.
2. Uncover the blind spot: member behavior
Most transparent PBMs don’t address the human element—how members actually use their benefits. RxSS closes that gap with behavioral insights and hyper-targeted engagement strategies that drive behavior change and plan savings.
3. Agnostic by design
RxSS works across PBMs, giving plans control over their data and strategy, allowing plans the ability to stay flexible and future-ready with any PBM transitions the plan requires.
4. Portability and continuity
If a plan switches from one PBM to another —traditional or transparent—whatever tools and experience members were accustomed to will go away. As an agnostic third party compatible with any PBM, RxSS gives plans the freedom to move and maintain the member experience and engagement. With RxSS in place, members also have a familiar resource to navigate the inevitable formulary and coverage changes and find suitable alternatives that can avoid disruptions in therapy.
5. Powerful connections
Value can extend further if the transparency solution is connected to resources with broad reach in pharmacy. As part of McKesson’s Prescription Technology Solutions, RxSS can work across the healthcare delivery system to offer next-generation patient access, affordability and adherence solutions. A broad portfolio of pharmacy, provider, payer, and biopharma servicesenable a connected, evolving platform that adapts to innovation.
The right pharmacy solution can be a critical companion piece to any traditional or transparent PBM. In addition to the reasons above, one like RxSS can serve as another set of eyes to make sure a plan isn’t letting cost-savings opportunities “pass through.”