Do you have a copay-card program in place? If so, your PBM may be reaping tremendous hidden profits off of it. So go ahead, ask your PBM to disclose all of their fees for this program… but be ready for some sticker shock.
If your PBM owns a retail or mail-order pharmacy, they’ve probably encouraged you to turn on an “auto-refill” feature for your plan. But did you know that this feature can leave patients with more drug quantity than they can actually use in a given year?
Your PBM probably tells you they’re saving you money with prior authorizations, but when is the last time you looked at your actual PA approval rates? PBMs that profit from dispensing tend to “leave the gate open” when managing PAs.
A guide to understanding the role of pharmacy benefit managers and how they've changed over time.
Understanding the three main PBM models can impact savings opportunities, service you’re expected to receive, and how much control you have over benefit design changes.