Managers who make employeehealth benefit decisions at the vastmajority of America's small and mediumbusinesses know little about pharmacybenefit management (PBM)organizations and how to avoid PBMstrategies that can drive up their company'shealth care bill. That is the conclusionof a new study bankrolled bythe National Community PharmacistsAssociation (NCPA) to shed light onwhat the independent pharmacygroup calls "the lack of necessarychecks and balances" to keep the PBMindustry honest.
After surveying business executivesresponsible for administering employeehealth benefit programs, theresearchers concluded that "most USsmall and medium decision makers aresimply unfamiliar with the activities ofPBMs?with 52% reporting they haveno idea whether or not PBMs offercost-cutting strategies for their businessesor employees."
The survey uncovered widespreadsuspicion among corporate health caremanagers regarding the practices ofPBMs. Eighty-three percent of healthcare decision makers expressed concernsthat PBMs might be chargingtheir employees more than the negotiatedrate for certain types of medications,and 80% raised the possibilitythat some PBMs may encourageemployees to switch drugs in order toincrease profits for the PBM.
"Our greatest concern is that PBMsplay a dominant role in the health caresystem, but there is virtually no privatesector monitoring or other regulationto govern their practices," said BruceRoberts, RPh, executive vice presidentand chief executive officer of NCPA."This allows PBMs to operate under acloak of secrecy that keeps businessesfrom making the best choices forthemselves and their employees."