Benefits Analysis & Should you use a PBM?

by | May 19, 2022 | Benefits

Is it time for a Benefits Analysis?

The world has seen a huge shift over the last couple of years in many different aspects of our day-to-day life but especially in the workplace. What attracts and retains quality employees and talent has shifted to the new normal and many businesses are realizing it may be time to reevaluate their current benefits/total rewards packages.

According to research by the Society for Human Resource Management, “Among 42% of HR professionals have implemented new or additional remote-work or flexibility options to reduce turnover, 32% have implemented new or additional employee referral bonuses, and 28% have introduced new or additional merit increases.”

Flex work, telecommuting and greater work life balance are a standard part of the workplace now. Employees expect affordable health insurance, pharmacy assistance, telemedicine, financial & health wellness options, and fair compensation. Employees have options and employers are increasingly having a hard time finding qualified staff to fill vacancies. Many companies and HR professionals are busy getting the basic day to day business done and lack the resources/time needed to be spent on a benefits analysis to identify gaps in their current offerings. There are only so many hours in a workday and being short staffed isn’t helping. 

How are your benefits stacking up in the post-pandemic workplace? When was the last time you took a comprehensive look at the Total Rewards package you are offering current & prospective employees?  If it’s been over a year – the time to start is now. Premier Workforce Solutions can help you get started and provide the creative solutions and bandwidth your team needs.

Premier Workforce Solutions can take a 360 degree view of your employee benefits package and help mitigate costs without compromising quality. Implementing a PBM is one effective way to mitigate prescription drug costs for both employers and employees.

What is the Role of Pharmacy Benefit Managers (PBMs)?

Pharmacy benefit managers (PBMs) are paid, third-party administrators of prescription drug coverage for insurance plans and employers. PBMs can provide a vast array of services including processing claims, negotiating discounts & rebates between payers and manufacturers, and developing/maintaining formularies (a list of prescription drugs covered by a plan).

PBMs manage plans for commercial health plans, self-insured employer plans, state government employee plans, Medicaid managed care organization (MCO) and Medicare Part D plans. 

What are the benefits to having a PBM?

PBMs can increase access to specific medications employees need at a discounted rate. The goal of a PBM is work as a go between with the employer and manufacturer to ensure both get a fair deal typically offering a solution to minimize prescription benefit costs. They can adjust the formulary on your plan to be more of a custom fit for your employees so they can have access to medications needed at a negotiated lower price than a health plan alone. 

PBMs have extensive relationships with a large network of retail and mail-based pharmacies which can offer employees/employers greater access to medications from multiple sources.

PBMs also can help implement several programs into your pharmacy plan that help reduce overall prescription costs and improper prescribing.

For example, Step Therapy programs help ensure patients have tried a less expensive drug that’s proven effective for a specific condition, before moving onto a more expensive drug. This can save the employer and the employee money; and leads to greater compliance as the patient can more easily afford the medication.

Prior Authorization programs are designed to prevent improper prescribing or the improper use/abuse of certain drugs. This not only prevents unnecessary expenses, but it also protects the safety of patients.  PBMs can help implement other programs designed to improve health outcomes for your employees focused on reducing waste and increasing adherence, managing high cost, specialty medications, and clinical drug management. **

** https://www.ehealthmedicare.com/faq/what-are-prior-authorizations-quantity-limits-and-step-therapy/

How do PBMs work with employers?

An employer will sign a contract with a PBM to design and maintain a prescription benefits plan. Typically, this is a 3-year contract and the employer and PBM work together (sometimes a broker can be involved) to build an ideal pharmacy benefit plan by selecting deductibles, co-payments, co-insurances, and clinical programs.

Once the plan is in place, the employer relies on the PBM to administer the prescription benefits, and to educate their employees about their coverage. Most PBMs also offer call centers, websites or apps that offer easy access to information about eligibility, refills, pricing, and coverage rules.