Articles & Resources

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.