It’s not rocket science. Competitive purchasing of prescription drugs is all about sourcing. PBMs do a lousy job of that so scratch that. Let’s build your own Rx plan.
Let’s start with generic drugs. You can capitate coverage for as little as $7 pepm or you can build your base plan around the HEB $5 Prescription Drug list and the Walmart $4 Prescription Drugs List.
Then you can add competitive pricing for brand name drugs, most of which will be maintenance drugs for overnight delivery. We have identified competitive pricing through multiple sources for this purpose. The savings will make your toenails curl.
Specialty drugs? Wow, the savings here will not only make your toenails curl, it will make your hair fall out. How about a $28,000 PBM price compared to a $6,000 direct purchase price? Yes, it’s that real.
There is no spread pricing or any other shenanigans in play here. All transactions are direct between buyer and seller with no one in between taking a cut.
You don’t need a PBM anymore. Your fiduciary duties demand it.
While you’re at it, you don’t need a TPA, PPO network or stop loss insurance either. We are in a different time now.
