EmpiRx Health: Redefining PBM Satisfaction with a Clinically-Driven Pharmacy Care Model
The Pharmaceutical Strategies Group’s (PSG) 2024 Pharmacy Benefit Manager (PBM) Customer Satisfaction Report highlights a range of insights into healthcare payers’ experiences with PBMs. While satisfaction with certain PBM services remains strong, the report underscores several areas where the industry must evolve to meet the needs of plan sponsors and healthcare payers, particularly around transparency, performance, and the need for industry-wide change.
Transparency Concerns: Rebates and GPOs
Healthcare payers responding to the PSG survey expressed moderate satisfaction with their PBMs’ overall transparency, but their perceptions regarding rebates and sources of revenue are mixed. The rise of rebate group purchasing organizations (GPOs) has added another layer of complexity, with many payers and plan sponsors voicing concern over the lack of transparency these structures can introduce. In particular, the way rebates are managed and the opaqueness of PBM revenue streams create frustration and uncertainty for payers trying to understand the full financial picture.
EmpiRx Health addresses these challenges head-on by offering a clinical savings guarantee that prioritizes clarity and accountability in pharmacy benefits care. Instead of volume-based rebates that incentivize more prescriptions and ignore health outcomes, EmpiRx Health lowers total pharmacy spending by optimizing every population’s drug mix. We save plan sponsors’ money by getting the right drug to the right patient, at the right cost. By working as a true partner, we ensure that every aspect of our services, from savings to clinical programs, is straightforward and easy to understand.
The Big 3 PBMs: Lagging in Satisfaction
The PSG reports that healthcare payers using one of the Big 3 PBMs—CVS Caremark, Express Scripts, or OptumRx—report lower satisfaction across multiple measures, including overall satisfaction and likelihood to recommend their PBM. As these large, traditional PBMs dominate the market, payers and plan sponsors are finding that their legacy models and lack of flexibility no longer meet the evolving needs of today’s healthcare environment.
One of the most interesting findings of the report is the satisfaction with clinical savings guarantees. While these programs rank lower in both awareness (51%) and usage (23%), they score higher in satisfaction, with 78% of respondents reporting that they are satisfied with these guarantees. This presents a crucial opportunity for PBMs that are committed to both clinical and financial outcomes to stand out by offering guarantees that improve savings while maintaining high satisfaction.
EmpiRx Health’s clinically-driven PBM model is built for this exact moment, with pharmacists at the center of our pharmacy care model. We are the only PBM where clinical pharmacists collaborate one-on-one with prescribing physicians to develop evidence-based recommendations that prioritize the most clinically appropriate, cost-effective medication therapies. As a result, our clinically-driven pharmacy care delivers measurable, guaranteed cost savings tied to improving patient health and well-being, helping plan sponsors to achieve what the traditional PBM model often cannot.
Appetite for Disruption: Healthcare Payers Want Change
One of the most striking insights from the PSG report is the strong appetite for change in the PBM industry. Many healthcare payers and plan sponsors are eager to be part of disruptive change and are actively seeking alternatives to the legacy PBM models that have dominated the market for years. The report shows that plan sponsors are ready for innovation, whether through new cost-containment strategies, clinical savings guarantees, or transparent business models that prioritize value over volume.
This is where EmpiRx Health’s clinically-driven PBM model truly differentiates itself. By holistically evaluating patients’ healthcare conditions based on their own unique needs and risk factors, we offer tailored pharmacy care strategies and solutions to best serve a plan sponsor’s specific membership. This approach, paired with a unique level of pharmacist-physician engagement, allows our clinical pharmacists to identify gaps in care, improve outcomes, and lower costs.
This customer-first approach enables customizable solutions that provide the flexibility and proactive partnership that plan sponsors seek but often don’t receive from the Big 3 PBMs. With our focus on real-time, evidence-based opportunities for individualized care management, EmpiRx Health provides plan sponsors with a tailored pharmacy benefit experience that helps them meet their specific goals—both clinical and financial.
Why EmpiRx Health is the Right Choice
In an industry where payers and plan sponsors are looking for change from the traditional, rebate-driven PBM system, EmpiRx Health stands apart. We are committed to leading the way in transforming the broken legacy PBM model with our clinically-driven approach. By focusing on true healthcare value and offering a clinical savings guarantee, we ensure that our clients receive both the financial and clinical outcomes they deserve.
As healthcare payers rightfully demand more from their PBMs, EmpiRx Health is ready to provide the solutions they need to maximize drug cost savings while improving patient health outcomes and quality of life. EmpiRx Health is the partner of choice for plan sponsors who want to be part of the change that the PBM industry so desperately needs.
For more information on how EmpiRx Health can help your organization optimize its pharmacy benefits while ensuring better health outcomes, contact us today. Let’s build a healthier future, both clinically and financially, together.
