The Problem With Prescription Drug Prices - 6 Degrees Health

The Problem With Prescription Drug Prices

What one city did to fight high drug prices reveals a drug supply chain in which just about every link can benefit when prices go up...



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Pulling Back the

Curtain on PBMs

Self Funded Payors

What is a PBM? Pharmacy Benefit Manager

Basic Services:

? Adjudicates Claims ? Checks Eligibility ? Manages Pharmacy Networks ? Establishes Formularies ? Consolidates Billing ? Pays Pharmacy Claims ? Reporting ? Customer Service ? Clinical Programs

PBMs are "fairly" equal in the Basic Services they provide.

3

Are PBMs and Payors

Aligned?

"Relatively few employers believe the goals of their PBMs strongly align with their own goals for managing employee health, productivity and costs..."

4

All PBMs are Not Created Equal

....that current pharmacy benefit management models lack transparency and are overly complicated."

Transparency &

Pass-Through

are not

the same.

PBM Model Traditional Transparent Pass-Through Hybrid

Revenue Streams No limits

Some limits Strict limits

Varies

Disclosure None

Required Required Sometimes

Traditional

PBM retains a network spread, rebates and other

revenues streams as compensation.

Pass-Through

PBM charges client the exact amount it pays pharmacies.

PBM is compensated with an agreed upon fee for service.

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