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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.


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Scripta™ is neither a pharmacy nor a doctor. The benefit service does not tell you what drug to take and does not participate in the drug selection process. Only your physician can determine the medications that are right for you. These alternative medications are options for less costly drugs that physicians may prescribe in place of the medications you are taking now. Scripta has reviewed your current medications only for the purpose of identifying potential cost savings for you to consider with your physician. Scripta has not analyzed the effectiveness or other therapeutic aspects of these medication alternatives. Accordingly, this report and any other forms of communication received from Scripta are not, nor should they be interpreted as, any form of treatment, drug regimen review, or provision of counseling or consultation by a prescriber, pharmacist or pharmacy. Do not stop taking your medication, change your medication, or start taking a new medication without being directed to do so by your physician and filling the prescription under the oversight of a licensed pharmacist. The alternatives set forth above may not be equivalent to your current medication, may interact adversely with your other medications, may not be indicated in light of your other conditions, may cause different or severe side effects, or may be less effective at treating your condition. Medication prices are approximate based on information provided by your pharmacy benefits manager, insurance plans, and/or employer, and may vary from pharmacy to pharmacy. Check with your insurance plan to obtain a full list of pharmacies where your prescriptions can be filled. All information herein is HIPAA protected, treated as highly confidential, and never shared with your employer.

Scripta™, Scripta Insights™ and The Best Meds at the Best Price® are registered trademarks of Scripta Insights, Inc. The contents of the site are for informational purposes only and not intended as a substitute for professional medical advice, diagnosis, or treatment. We do not recommend or endorse any specific prescription drug or pharmacy that may be mentioned herein. Reliance on any information provided by us, our affiliates, employees or others is solely at your own risk.