Prescription drug costs are rising at an alarming rate. You are reminded of this this every time you fill your prescription. Here is how our staff of pharmacists and medical experts are working with the industry to lower these costs for you.
There are three main programs to help manage drug costs:
- Prior Authorization – making sure your doctor is making the best clinically effective drug choice
- Step Therapy – trying other medications first to see if they’ll work before moving on to the more expensive option.
- List (formulary) Tiers – list of covered drugs encouraging the use of lower-cost drugs.
Strength in Numbers
Insurers work with outside companies called pharmacy benefits managers (PBMs). This helps insurers get the best understanding of rising costs for prescription drugs. Insurers team with a PBM to handle the prescription drug benefit part of your health plan. The PBM connects the insurer with the pharmacy. We work with Prime (Prime Therapeutics). Prime is a privately-held company that serves 22 million members.
By working with Prime we are able to have a national look at trends in the pharmaceutical industry. We are also able to build relations to negotiate pricing for brand name and generic drugs.
Role of a PBM
PBMs work directly with pharmacies and establish a network that you can use to get your prescriptions filled. This includes mail-service pharmacy. Prime negotiates with drug companies and updates our covered drug lists and pharmacy networks. This helps to keep costs as low as possible for you, our customers. PBMs do the following:
- Set the best drug benefits for our plans
- Fill prescriptions
- Manage programs to keep costs lower for customers
The ultimate goal for working with Prime is for you to pay the lowest cost without giving up the effectiveness of the medications.