The self-funded insurance model offers employers a lot of choice in their healthcare plan, but having a lot of choice also means having to make a lot of decisions. Sometimes, in an effort to simplify the decision process, employers will take whatever recommendation a broker makes regarding their pharmacy benefits manager. Some employers may not realize they even have a choice when it comes to their PBM.

With pharmacy benefits accounting for a significant percentage of total healthcare costs, it’s important that companies choose the right PBM for their needs. And that’s where partnership comes into play. Do you want a vendor or do you want a partner? 

In this case, a vendor is purely transactional. They’re providing your pharmacy benefit, which means they’re going to pay the claims that come through from your employees. They might send you a report that breaks down the types of claims paid, and they’ll communicate if there are any restrictions on what they’ll cover. But ultimately, it all comes back to their primary focus being on those transactions. 

A partner goes the extra mile. They take the time to learn what’s important to you and your business and customize the pharmacy benefits plan to your specific needs. And they adapt as your business changes over time or as the pharmacy industry changes. 

Does your PBM ask lots of questions up front to identify what’s most important to you before they recommend a plan structure? Do you have a dedicated account manager who knows your business and can help when you have questions? Are they willing to sit down and explain in detail how your plan works and demonstrate true transparency by showing you the contracts? 

If you’re looking to develop a partnership with your PBM, contact us today to talk about your needs and how MaxCare might be able to help.