Why Use A PBM When You Can Do This Instead?
“We have no choice, it’s a moral issue” announced the company president during an Open Enrollment meeting. “We are not going to garnish your wages anymore for things you can’t afford!”
“Look at George over there” as he points to the red-faced employee cowering in the back. “His paycheck is a negative $2,000 every pay period. He can’t afford that. He has a wife and family to feed, children to clothe, bills to pay so we make up for it by garnishing your wages so George can continue to take home a paycheck.”
Employees spontaneously mutter in sarcastic unison “YOU’RE WELCOME GEORGE!” as he smiles and bows in gratitude.
“Effective next month we are firing our PBM and changing the way we source our prescription drugs” he continued. “We will no longer immorally garnish your wages for prescriptions you can’t afford!”
A momentary silence. …..Then joyous eruption, hooping and hollaring, back slapping and dancing filled the room, causing curious stares and pauses in offices nearby as walls vibrated and dogs howled throughout the neighborhood.
As the excitement fades to expectation an arm is raised. “How will this change affect us? Will we still be able to get the drugs we need and how much will it cost us? asked Joe Sixpack from maintenance.
“Glad you asked Joe. For starters you’re take-home pay will increase!” said the company HR Director. “Pull up slide 7 Emily.”
“Slide 7 highlights the new program. Let’s go through each one by one” purred the nice, freckled HR lady with curly hair as she nervously popped a mint disguised Xanax.
- There are over 35,000 FDA approved generic drugs. The good news is you can afford all of them
- You can’t afford drugs at Walgreens and CVS pharmacies as they are the highest cost retail pharmacies on the planet so we will make sure you can get the same drugs somewhere else at prices you can afford.
- HEB and Walmart both have hundreds of prescription drugs for $5 or less for a 30 day supply so we won’t have to garnish your wages for these. Your co-pay will be $5 for these FDA approved drugs.
- For those of you taking those expensive brand name specialty drugs you see on television, some of which cost hundreds of thousands of dollars a year, we have really good news. Most employers everywhere else are immorally garnishing wages to pay for these drugs. We will be happy to give you an outstanding reference should you decided to seek employment elsewhere and you may even qualify for severance pay should you decide to do that.
- More good news! If you are taking a drug we will no longer be covering, which are few and far between, we can trigger a Plan Document provision which will allow you instant access to an individual health insurance policy that covers the drug you need. Bear in mind you have more than 35,0000 FDA approved prescription drugs covering every therapeutic category should you continue on our group plan.
- For those of you on GLP-1 drugs there’s even more good news. You don’t need them and can’t afford them for weight loss alone so we are no longer going to garnish wages to cover them for weight loss. A gym membership is a lot cheaper and better for you. For those of you on GLP-1 drugs for diabetes we have found cost effective sourcing that will reduce costs 50% or more. You won’t be able to get these drugs anywhere you like, only though sourcing we establish for you.
“And now the best part! Emily…………pull up slide 8 please”.
SLIDE # 8
“Factoring in the projected savings under our new PBM-less Rx program, we are reducing garnishment across the board by $5,000 a year for every full-time employee starting today!” shouts the now fully sedated HR lady. “This means you will get back $5,000 of your own money to do with as you please!”
Story Update: Prescription drug cost dropped 65% and no one has gone without the drugs they need. Jackson who was on a $250,000 prescription still works for the company but gets his Rx through a BCBS individual policy. Sonja, assistant bookkeeper gets her $500,000 drug free through a manufacturer’s assistance program. Sam (she’s a girl) gets her GPL-1 drug that was costing $14,000 per year for less than half of that. And the company is hiring new people.
This is a true story. The details are not. A small rural Texas county has done all of this and yes, gave every single full-time employee a permanent $5,000 annual raise due to Rx savings achieved.
