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Escalating prescription drug costs continue to take their toll on both plan sponsors and their enrollees. Various efforts are under way to manage the symptoms of increased pharmacy costs, such as the campaign to legalize drug importation and the transfer of more of the cost burden to enrollees. But plan sponsors need to cure the problem instead of treat the symptoms, and many feel transparency in pharmacy benefits is a solution. Because there are many interpretations of what a transparent pharmacy benefit entails, there is much confusion in the marketplace. And some disagreement exists over whether this approach actually saves employers money. Transparency refers to full disclosure of rebate revenue and other profits made by the PBM as a result of its contract with a particular client. PBMs, which handle the majority of U.S. drug coverage, possess strong negotiating power, but critics allege that they charge more for drugs than they actually pay for them. Transparent business models for administering the pharmacy benefit are becoming increasingly attractive to payers and, as a result, to vendors. Demands for transparency are opening up the PBM market to new vendors and business models that are poised to compete directly with traditional PBM contracts. Employers are even forming coalitions to tackle the issue. More than 30 large employers have joined the Rx Collaborative, which seeks to reduce employer drug costs through strategies such as transparency. And in 2004, 50 large companies representing more than 5 million lives formed a coalition to explore whether it would be better to deal directly with drug manufacturers instead of PBMs. Several lawsuits have been filed against PBMs surrounding the idea that PBMs have a fiduciary duty to their clients that supersedes their profit maximization goals. Many state legislatures are debating the issue as well, and Georgia, Maine, Maryland, North Dakota and South Dakota have passed PBM laws. Get details on how different transparency strategies impact employers, health plans and PBMs. The top executives from PBM HealthTrans and a consultant from Pharmaceutical Strategies Group will explain transparency options and trade-offs that exist with these options. Find out…
Learn
about the pros and cons of transparent arrangements for the pharmacy
benefit … and how to maximize the value of the benefit.
JACK McCLURG is a founding member of HealthTrans, L.L.C., and serves as the CEO of the Colorado-based PBM that was founded in 2000 based on the concept of promoting full disclosure and tools that empower clients to control their own pharmacy costs. HealthTrans processes over 70 million prescriptions annually, with an annual drug spend of $3 billion and 13 million covered lives. Prior to forming HealthTrans, Mr. McClurg was vice president and chief information officer of Integrated Pharmaceutical Services, the PBM subsidiary of Foundation Health Systems, Inc., where he provided executive technical and business leadership, and was responsible for operations of claim processing and decision support services for over $1.4 billion annually in pharmaceutical transactions. LOUIS HUTCHISON, JR., is a founding member of HealthTrans, L.L.C., and serves as the chief operating officer. Prior to joining HealthTrans, Mr. Hutchison was president of Systems Xcellence USA, Inc., a wholly owned subsidiary of Systems Xcellence, Inc. of Milton, Ontario, Canada, a software development company, where he also held the titles of vice president of strategic operations, vice president of corporate development, and vice president of North American sales and marketing. His background also includes work in business and technology consulting and in software. KEVIN WAITE,
MS, RPh, is a pharmacy benefit consultant with Pharmaceutical
Strategies Group (PSG). He provides pharmacy benefit consulting services
for large employers, health plans and the public sector, including
PBM procurement and contracting, benefit design, formulary/rebate
programs, benchmarking and budgeting, and performance review/continuous
quality review. Prior to joining Pharmaceutical Strategies Group,
Mr. Waite was vice president of business development for SXC Health
Solutions, Inc. He has also held vice president and director-level
positions with various health care companies and has been responsible
for the integration of retail, mail and specialty injectable pharmacy
services.
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Listeners will also receive practical written information about maximizing pharmacy benefits through transparency.
For further information call 800-521-4323 or e-mail customerserv@aispub.com |
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