A mid-sized organization with 4,552 members asked us to review their pharmacy benefit. Their current annual spend: $9.8 million.
Here’s what the analysis showed.
Spread Pricing on Generics
Twenty generic medications carried spread pricing that cost this organization $232,414 annually. These are everyday generics, not specialty drugs or complex medications.
Brand Name Spending
Three medications accounted for significant avoidable costs:
- Novolog: $73,984
- Humalog: $17,220
- Percocet: $33,496
Across 219 brand name prescriptions filled for 46 members, the organization overpaid by $133,335. In most cases, a generic or biosimilar would have provided the same clinical outcome.
The Full Picture
As The Fiduciary and The Fully Disclosed PBM®, we provided this organization with a 16% savings guarantee, projecting $2 million to $2.3 million in annual savings.
The examples above represent a portion of what we found. A complete review of the pharmacy benefit revealed additional opportunities.
How This Occurs
Most PBMs are not contractually bound to act in your best interest. Spread pricing generates revenue. Brand dispensing when generics are available generates revenue. Your formulary decisions become someone else’s revenue source.
A Fiduciary PBM is contractually and ethically bound to act in your best interests. That means proper network pricing management, elimination of spread pricing, and formulary protection from wasteful spending.
For Your Organization
If you manage similar member counts and pharmacy spend, the question is straightforward: Do you know what you’re actually paying?
DisclosedRx provides prescription analysis at no cost.
DisclosedRx operates as The Fiduciary and Fully Disclosed PBM®, providing organizations with complete visibility into pharmacy benefit costs while serving as a fiduciary partner.