The Legacy Volume-Driven PBM Model Does not Equal Value for Plan Sponsors and Members
Too many plan sponsors find themselves saddled with pharmacy benefits plans that are volume- and rebate-driven, with restrictive formularies or reduced medication access. This standard operating system of traditional PBMs incentivizes increased claims volume to maximize rebates. As a result, members pay more or take medications they don’t really need. Equally important, this legacy PBM model fuels soaring prescription drug costs, a primary driver of overall healthcare spending.
This legacy PBM business model is fundamentally misaligned with the needs of benefit plan sponsors and patients. A volume-driven approach fails to address the growing concerns around sustainable drug spending. Nor does it ensure that the patient receives the most clinically appropriate medication therapies. Coupled with the growing usage and cost of specialty medications, these self-serving practices put enormous pressure on plan sponsors, leading to an ongoing cycle of poor plan results and substandard patient health outcomes.
There is a better, value-based alternative that puts pharmacists at the center of the pharmacy care model. It’s founded on a unique clinically-driven approach to managing the seemingly constant rise in prescription drug costs and ensuring the health and well-being of patients. This clinically-driven PBM model attacks the prescription drug cost problem “at the pen,” when the physician writes the prescription for the patient.
At EmpiRx Health, our clinical pharmacists use AI-powered population health technologies to holistically evaluate patients’ healthcare needs based on their own unique risk factors. These pharmacists collaborate with prescribing physicians to develop evidence-based recommendations that prioritize the most clinically appropriate, cost-effective medication therapies.
In the case of one 61-year-old patient, our clinical pharmacist identified that they were prescribed a drug that was not FDA-approved for their condition. After engaging the prescriber, it was agreed that the condition was likely drug induced. The patient stopped taking the drug and recovered using over-the-counter medication. As a result, the plan sponsor saw $49,436 in annual savings and the patient avoided a potentially serious adverse reaction.
Using this clinically-driven pharmacy care model, EmpiRx Health ensures that its members are getting the right drug, at the right time, at the right cost. This substantially lowers drug spending for our plan sponsors and, most importantly, produces measurably better patient health and quality of life.
From day-one our mission has been to fundamentally transform pharmacy care by focusing on true healthcare value for our plan sponsors and their members. We’ve done that by replacing the flawed legacy PBM model, which prioritizes volume-driven profits, with a clinically-driven, customer-first approach that is fully aligned with the interests and needs of our customers and their members.
Ready to choose value over volume? Contact us to learn more.
