Friday, April 8, 2016

Anthem Express Scripts’ Lawsuit Should Incentivize Municipalities to Seek Independent Pharmacy Benefit Consulting Firm

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

Pharmacy benefit lack of expertise by using a Medical/Employee Benefit consultant, Carrier or TPA, versus an independent pharmacy benefit expert like PBIRx, hits municipalities’ and taxpayers’ bottom line. There is so much money left on the table and no one seems to care! 
After several attempts at negotiation and using an independent third party pharmacy benefit expert, Anthem is now suing Express Scripts for an estimated $13 billion in overpayment of pharmacy benefit costs. If Anthem is using an independent pharmacy benefit expert, why are the many municipality clients they serve not doing the same? Why are their municipality clients not concerned about what percentage of the $13 billion that Anthem is trying to get from Express Scripts is representative of their budget? Does anyone think that if Anthem gets a concession from Express Scripts that Anthem will credit the pharmacy benefit costs for their municipality clients? We do not think so!
Anthem | Express Scripts | Lawsuit | Anthem Sues Express Scripts
Municipalities typically go out to bid for their medical benefits by requesting an RFP for a Health or Other Employee Benefit/Medical Consultant or their TPA/Carrier recommends a PBM; however, they rarely request an RFP for an independent Pharmacy Benefit Consultant, even though pharmacy costs now represent up to 30%-40% of total employee benefit costs and is increasing annually.     
Taxpayers, just like ushave no idea what is going on at our local Town Hall or Board of Education even though our taxes go up every year for the rich benefits that municipal workers and their unions demand. With an independent Pharmacy Benefit Consulting firm like PBIRx, municipalities’ budgets would benefit, while employees and union members maintain their benefits and taxpayers save money…a win, win, win situation!
An Employee Benefit, Medical Consultant, Carrier or TPA cannot possibly know and follow all the complexities that are involved and constantly changing in pricing for the pharmacy benefit, along with the ability to analyze and audit like an independent Pharmacy Benefit Consulting firm. Employee Benefit/Medical brokers/consultants and TPAs/Carriers typically go the easy route of a spreadsheet, when like most things, i.e. the PBM profit, is buried in the details in the Pharmacy Benefit Agreement or when using a TPA or Carrier “very little” information related to the pharmacy benefit pricing is stated in the TPA or Carrier Agreement.    
Auditing the pharmacy benefit, which is integrated in with the medical TPA or Carrier, is almost impossible because of the lack of language and calculation methodology of pricing in their TPA/ Carrier Agreements. Even when municipalities contract directly with a PBM, they rarely audit that Pharmacy Benefit Agreement, which typically allows only auditing of the previous 12 months, even though pharmacy benefit drug spend is in the millions of dollars.  An independent Pharmacy Benefit Audit will also provide information related to the competiveness of the PBM contract.
For over 25 years, PBIRx, an independent third party Pharmacy Benefit Consulting and Audit Company, works directly with municipalities and has “Strategic Broker/Consultant Partnerships”, as well as “TPA Strategic Partnerships”. These PBIRx Strategic Partners understand  the need to work with an expert that employs a staff of mature and seasoned professionals with a sole focus only on pharmacy costs. To speak with one of  the PBIRx experts and learn how you can be helped next with your pharmacy benefits, please visit or call (888) 797-2479.

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