Traditional PBMs promise clients huge savings by driving higher drug volumes and chasing higher rebates, which are typically related to expensive branded medications. The problem is that this PBM approach really is just a healthcare industry version of the old shell game, offering the illusion of savings but delivering nothing of the sort.
We call it “PBM Math.” The traditional PBM companies, especially the big three players who control 80% of the market, use this fuzzy math to justify their opaque business practices that prioritize their own profits over patient health outcomes. For example, when a traditional PBM promises major drug cost savings based on providing rebates on a high-cost specialty or non-specialty branded medication, that’s usually the starting point for PBM Math. The PBM pushes those high-priced drugs to clients because they also get a big cut of the rebates. Usually, it’s not because those medications were the most clinically appropriate or effective for the patient.
It’s akin to a store offering a 50% discount on a product that they marked up 200% in the first place. Smart shoppers have learned that this is not actually a great deal given the hugely inflated original price. Plan sponsors are also getting wise to these kinds of questionable business practices and are demanding greater transparency from their PBM partners. In fact, there is a slew of pending PBM reform bills before the new Congress that mandate greater pricing transparency to combat these legacy practices employed by the largest PBM companies.
EmpiRx Health was founded a decade ago on a fundamentally different – and we believe, better – value proposition that rejects the entire concept of PBM Math. Instead of the volume- and rebate-driven model used by the traditional PBMs, EmpiRx Health takes a clinically-driven approach to pharmacy care that puts clients and their members first by putting pharmacists at the center of our service model.
How does that work? EmpiRx Health provides a Clinical Savings Guarantee that quantifies the savings clients will receive through the company’s pharmacist-led pharmacy care process. First, we identify client opportunities for optimal patient care and greater prescription drug savings using our Population Health Engine. This proprietary technology is integrated into Clinically™, EmpiRx Health’s AI-powered pharmacy care technology platform.
Our pharmacists then use the EmpiRx Health Clinical Savings Tracker to track and verify the client’s savings and present auditable results on a regular basis. Savings are calculated in a contract year and reset annually.
Crucially, if EmpiRx Health fails to deliver on the agreed-to Clinical Savings Guarantee, we reimburse the client dollar-for-dollar. That’s why it’s called a “Guarantee!”
We have developed a Clinical Savings Calculator to give you a clear picture of how much EmpiRx Health can save you on your pharmacy benefits program. Check out our Calculator here and discover how much you can save with clinically-driven, customer-first pharmacy benefits care.
