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  • Writer's pictureJake Baker

What is a Pharmacy Benefit Manager (PBM)?

A PBM is a third-party entity that operates as an intermediary between health insurance plans, pharmacies, and prescription drug manufacturers. The primary objective of PBMs is to streamline the prescription drug distribution process, enhance cost-effectiveness, and ensure that patients have access to necessary medications. They negotiate contracts with drug manufacturers, establish drug formularies, process prescription claims, and administer pharmacy networks for health insurance plans. By negotiating bulk purchasing agreements and promoting the use of generic drugs, PBMs aim to reduce prescription drug costs and provide valuable cost-saving services to health plans.

However, the role of PBMs in healthcare has become increasingly contentious due to several problems they have been associated with.

  1. One major concern is their lack of transparency in pricing negotiations and rebate arrangements with pharmaceutical companies.

  2. Hidden rebates and incentives can lead to inflated list prices for drugs, while patients may still pay a substantial portion of the cost at the pharmacy counter.

  3. The complex pricing structure and rebate system can make it difficult for consumers to understand the true cost of their medications.

  4. Patient steering and prioritizing their own profits over patient welfare. This can lead to instances where PBMs encourage the use of certain drugs based on financial considerations rather than clinical efficacy, potentially limiting patient choice and access to the most appropriate treatments.

  5. PBMs have been accused of contributing to the rising prescription drug costs by operating in a way that benefits their financial interests rather than the interests of patients and the healthcare system.

PBMs are supposed to play a crucial role in managing prescription drug benefits, aiming to control costs and improve access to medications. However, the lack of transparency and potential conflicts of interest have led to concerns about their impact on prescription drug pricing and patient care, contributing to the ongoing debate surrounding healthcare affordability and accessibility.

How Rescription is different:

What truly distinguishes Rescription from other PBMs is our unwavering commitment to transparency in drug pricing which includes providing a price for every drug. Unlike traditional PBMs that engage in practices like spread pricing and hidden drug markups, Rescription operates with complete openness. We believe in dispelling the smoke and mirrors that often surround PBM operations.

Central to the Rescription program is a remarkable advantage – an average savings of 70% on high-cost and specialty drugs. These specialized medications typically constitute a substantial portion of an employer's healthcare expenditure. This is where Rescription excels, offering a solution that other PBMs simply cannot match.

When it comes to addressing the challenges of rising healthcare costs and complex pharmacy benefit management, Rescription stands as a beacon of integrity, providing both unparalleled transparency and remarkable savings. It's not just about offering an alternative – it's about revolutionizing the industry with a customer-centric approach that empowers employers and their members.



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