Pharmacy Benefit Managers: What Are They and How Can They Help?

Prescription drugs can be exceptionally costly, and prices continue to be on the rise. According to Bloomberg, Americans spend an average of $1,200 per person per year on prescription drugs — more than anyone else in the world. 

But there are ways you can help employees drive these costs down. One of those ways is leveraging a pharmacy benefit manager to control your healthcare spending and make your employee benefits more affordable.

What is a Pharmacy Benefit Manager?

Pharmacy benefit managers (or PBMs) are companies that can help manage your prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers and more. 

By mediating between insurers and other members of the healthcare industry, PBMs can help negotiate customer contracts to get the best rates, ultimately helping employees prioritize their wellness without unnecessary costs. 

How Can a Pharmacy Benefit Manager Help My Business?

At Cornerstone, our clients that are self-funded or have an interest in creating a solution to reduce their prescription drug spend may benefit greatly from working with pharmacy benefit managers. 

PBMs are “behind-the-scenes” negotiators to control drug spending and lower medication costs for your employees. Our clients often see 30 to 35% — often as high as 50% — of their claims costs coming from prescription drugs. An effective PBM and management program can be implemented to save your employees hundreds of thousands of dollars.

How Does Cornerstone Work With Pharmacy Benefit Managers?

As an employee benefits company, Cornerstone works with several PBMs directly to ensure the correct fit for our self-funded clients. We will personally “shop” for the right pharmacy benefit manager for your needs.

You may have lots of questions regarding prescription drug coverage, such as:

  • How are these prescriptions covered? 
  • How are rebates from the manufacturer handled?
  • How do you determine which drugs are eligible for the rebates?
  • What type of clinical management programs are used in conjunction with the prescription drug list to ensure the best fit and correct dosage?

By working with insurance consultants like Cornerstone, we can help you have these conversations — and more — with your PBM. We have access to the tools, knowledge, expertise and relationships to ensure our self-funded clients have the right PBM to keep them as competitive as possible while offering high-quality benefits to their employees.

Cornerstone’s benefits administration specialists also have the technology that can analyze your business’s healthcare claims to know exactly how your benefits are being used so you can rest assured we’re making the best-educated decision for our clients’ programs.

Data analytics continues to be an extremely effective tool for managing claims within a self-funded client and having an efficient PBM can continue to drive your costs down.

Healthcare and employee benefits administration can be complex. Let Cornerstone’s experts help your company find the best rates so your employees can stay happy and healthy. Get in touch today.