A health plan had one member taking Imatinib, a specialty medication. Over one year:
The plan paid: ~$120,000The member paid: $6,000Total: $136,000
The same medication, same pharmacy, same day, through a straightforward pharmacy benefit: $1,300 for the entire year.
How does this happen?
When you lack visibility into actual drug costs and rebates aren’t passed through, there’s nothing stopping a PBM from charging whatever they believe you won’t question.
Here’s another example:
Dicycling costs $247 through GoodRx with no insurance. A health plan with a traditional PBM paid $1,278 for the exact same prescription.
This isn’t sustainable.
At DisclosedRx, we operate as The Fiduciary and The Fully Disclosed PBM®.
You see exactly what we pay.
You pay exactly what we pay.
100% pass-through pricing. 100% rebate pass-through. One admin fee and a
share of the savings we generate. Not a dime more from anywhere else.
When a member pays $6,000 in copays for medication that should cost $1,300 for the year, something is fundamentally wrong.
When your plan pays $130,000 instead of $1,300, that’s money that could have supported other benefits or kept premiums lower.
You deserve to know exactly what your drug costs are.
No shell games, ever.