“There is no such thing as an unsolved problem” – Bill Rusteberg
Know of a source that provides real time point-of-service retail pharmacy claim adjudication for self-funded health plans as an alternative to using a PBM?
Electronic transfer of funds is not expensive nor is it rocket science. It doesn’t cost $8 per script. Not even close. More like a fraction of a penny unless greed is a factor.
Setting rules should be easy as it’s done all the time in other applications. That kid in the back of the class hunched over his computer can probably do that for you.
The missing link is capturing the ever so allusive Enticement Commissions (rebates) imbedded in pharmaceutical manufacturer’s wholesale pricing, lurking opaquely within the deep depths of the Black Hole of pharmacy finance. But I’m sure there is an unobstructed pathway there too.
Imagine the savings to be had if plan sponsors could dictate the rules and eliminate value draining middlemen.
Surely someone somewhere has thought of this. And doing it. If not it’s an opportunity worth exploring.
