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Are You Getting the Most Out of Your Pharmacy Benefits?



Back in August, Scripta surveyed 77 human resources professionals at self-insured companies to reveal the method behind their plans when it comes to pharmacy benefits. Results showed that employers and members could be saving a lot more with the right tools and resources. To help you get your pharmacy spend under control, we’ve collected some best practices based on our survey results and compiled them into a list of helpful tips.

Of course these steps can be taken for your next open enrollment season, but there is also no better time than now. The sooner they are implemented, the more you can save! Check out what the Scripta team suggests:

  • Don’t get locked in: Most PBM contracts are for three-year terms, making it impossible to keep your pricing current in a market that changes daily. Try to negotiate for shorter terms, or insist that your contract include a “market check” clause that allows annual adjustments.

  • Reevaluate as often as possible: The prescription drug market changes almost daily. It’s critical that companies reevaluate their plan design as often as possible to keep up with these changes, at least once a year if not more.

  • Get a second opinion: It’s always a good idea to consult a third-party for analysis of your PBM bill, which ensures an unbiased opinion on savings. This gives you a clear picture of the current spending and market changes.

  • Don’t blindly accept increases: There are no good reasons to accept astronomical increases year-over-year. Most companies budget up to 10% each year, but you could save by taking time to reevaluate your plan instead of just agreeing to the increase.

  • Don’t leave money on the table: If you don’t have guaranteed rebates, you’re leaving money on the table. Wouldn’t you rather be sure your members are taking the best medication at the lowest price, as opposed to a costly alternative just to get a rebate?

  • Evaluate your GUR carefully: Don’t be fooled. Just because your Generic Utilization Rate comprises the majority of your fills (drug mix), doesn’t mean you can’t save by buying the most appropriate Generic instead of the often inflated price your PBM has on its formulary.


To see full findings of Self Insured Employers: Making the Tough Decisions on Pharmacy Benefits, download our full report here.