If you are an employee or work on your employer’s benefits team, ask your health care broker or consultant whether spread pricing is baked into the pharmacy benefits  insurance plan that you are paying for.  As explained elsewhere  on this website,  your broker might be getting a kickback from the PBM that is used by your group insurance plan,  so that person who is supposed to be your advisor may not be entirely forthcoming with you. If that is the case, find an advisor who is not accepting industry cash who can give you some straight answers about the design of your employee pharmacy benefits .

PBM’s also rake in your dollars through other hidden schemes, including rebates  paid by pharmaceutical companies. Most health plans assume that since they are paying for the prescription drugs, they should get any manufacturers’ rebates. However PBM’s often do not disclose the size of the rebate, which allows them to keep some or all of it for themselves.

When the Montana state government benefits plan found that it was getting taken by this exploitation, its chief officer  Marilyn Bartlett pulled the state plan out of this bad deal and she found a PBM , Navitus Health Solutions, that would not take any spread and would pass all manufacturers’ rebates on in full. The year after this change, the state saved an average of almost $16 on each prescription and saved $2 million on the spread while its revenue from rebates jumped from $3.5 million to $7million.   

If you hire a health care benefits consultant who is paid only by you, not by any insurance carrier or drug manufacturer , he or she can guide to PBM’s who like Navitus Health Solutions will not take any spread but instead  seek out  and pass on to you manufacturers’ rebates in full.

See the Resources section of this website  for further information.