February 22, 2024

Self-funded employers often rely on pharmacy benefit consultants to guide them through the complexities of securing the best pharmacy benefit pricing and contract terms with a PBM. However, glaring issues can arise for employers when their consultants have preferred PBM relationships or will only work with a select number of PBMs. PBM-agnostic pharmacy benefits consulting can help prevent a conflict of interest which could compromising the quality and objectivity of strategic advice.

The Risks of Preferred PBM Relationships

Preferred PBM relationships come in many shapes and sizes. Consultants may receive additional commissions for recommending a specific PBM, receive payment in exchange for allowing a PBM to present to clients or operating a PBM coalition. These arrangements can skew the consultant’s recommendations, leading them to take the “easy path” to place a new client and, in some cases, prioritize financial gain over the client’s best interests.

One of the primary concerns with preferred PBM relationships is the potential for biased advice. When a consultant receives additional commission from a particular PBM, there is an incentive to favor that PBM, regardless of whether it offers the best value or service for the client. This scenario can lead to suboptimal contract terms and higher costs for the employers and plan members.

The Downside of PBM Coalitions and Limited Flexibility

A PBM coalition is a scenario where consulting firms funnel groups into a single PBM or a small group of PBMs. This arrangement comes with pre-negotiated pricing and contract terms. However, coalitions have drawbacks. While they may streamline the process of placing a group with a new PBM, they limit the range of options available to clients.

This restriction can be particularly unfavorable when it comes to plan design and clinical flexibility. Employers might find themselves locked into a one-size-fits-all approach that does not cater to their specific needs or the needs of their members.

Furthermore, coalition agreements often impose constraints on access to important data. This limitation can hinder the client’s ability to make informed decisions about their pharmacy benefit plans. Without this data, they lack a complete picture of how their plan is performing or how to optimize it.

The Value of an Objective Opinion

In contrast, working with a PBM-agnostic pharmacy benefits consultant offers advantages. With an unbiased perspective brought to the table, they can evaluate a diverse set of PBMs while prioritizing the client’s unique needs. This approach ensures that recommendations are based solely on the client’s interests, leading to more tailored and effective pharmacy benefit solutions.

A PBM-agnostic consultant can also provide a comprehensive analysis of the market during an RFP, highlighting the strengths and weaknesses of various PBMs. This transparent insight empowers organizations to make well-informed decisions that align with their financial and plan-performance objectives. Additionally, it fosters a competitive environment among PBMs, which can lead to more favorable contract terms and pricing for the client.

 

In the world of pharmacy benefit management, the right consultant is critical to the financial health of an employer’s benefit plan. Engaging with a consultant who maintains PBM-agnostic practices ensures that recommendations are free from bias and solely focused on the client’s best interests. Such a partnership not only promotes transparency and trust but also paves the way for more effective long-term management of your pharmacy benefit costs.

Our team of experts and industry insiders is 100% PBM-agnostic and ready to help you save. Contact us if you’re interested in a no-risk assessment of your pharmacy benefit plan!

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