Your PBM may not be giving you the best prices (because it’s not always in their best interest to do so).
In theory, Pharmaceutical Benefit Managers (PBMs) are are supposed to simplify things by dealing with claim transactions between pharmacies and health-plan sponsors, as well as use their size to negotiate pricing with drug makers and those same pharmacies. Unfortunately, that’s not the way it most often works.
Today, PBMs are more often both benefit administrator and provider, and most enjoy very close ties with drug manufacturers. Because of this, PBMs often end up disproportionately influencing health care decisions, in the interest of maximizing shareholder profits and often to the detriment of patients and plan sponsors.
PBMs often control prescription drug plan formularies and get rebates from the drug manufacturers for favoring certain brand-name drugs over others. These deals are often shrouded in secrecy, with PBMs frequently collecting payments without sharing information with health plan sponsors. Such profit incentives can actually result in higher-priced medications being recommended to customers.
Scriptas is a completely different kind of beast.
The recommendations provided by Scripta are based on physician input and actual drug costs, and are not driven by rebates or directed by internal profit margins. Our goal is to support the doctor-patient relationship and thereby to create a healthier, more productive workforce and a culture of cost containment that supports the plan sponsor’s business goals.