As the healthcare industry faces increasing scrutiny over drug pricing, the cost-plus model in pharmacy benefits has emerged as a potentially more transparent and consumer-friendly alternative to traditional pricing models.

As healthcare systems, employers, and payers wrestle with how to cover these high-cost therapies, the question becomes: What does appropriate coverage of specialty drugs look like?

These independent experts help plan sponsors navigate the pharmacy benefit manager (PBM) landscape, ensure transparency, and implement cost-containment strategies that don’t compromise the quality of care.

Managing pharmacy benefits is one of the most complex and expensive parts of running a healthcare plan. Pharmacy Benefit Managers (PBMs) are supposed to control drug costs, manage pharmacy claims, and negotiate rebates with manufacturers.

In today’s market, every PBM claims to be transparent. It’s become table stakes in RFPs and sales conversations. But just because a PBM uses the right words doesn’t mean they’ve changed how they operate.

Auditing your PBM is overwhelmingly an advantage. A well-structured audit can uncover hidden costs for your members. Verifying compliance ultimately protects both you and your organization from ERISA concerns.

At Crystal Clear Rx, we talk with plan sponsors every day who feel uncertain about what they’re actually paying for when it comes to their pharmacy benefit. Here’s our honest take, if it’s done right, a market check is one of the most efficient ways to protect your plan and ensure you’re not leaving money on the table.

The battle unfolding in Arkansas between two of the country’s largest PBMs, Express Scripts and CVS Caremark, and the state government is more than pharmacy ownership. It is about transparency, accountability, and who ultimately controls the pharmacy benefit supply chain.

The recent Federal Trade Commission (FTC) complaint against the three largest pharmacy benefit managers (PBMs) has brought critical issues surrounding insulin pricing and patient access to the forefront.

Managing the Costs of GLP-1 Drugs: A Strategic Approach June 2024At Crystal Clear Rx (CCRx), we understand that the rising popularity and costs of GLP-1 drugs have raised many questions and concerns. We aim to provide clarity and guidance on managing these expenses...