Whether you’re new to the self-funded healthcare market or are simply making some changes to your plan, choosing a pharmacy benefits manager is an important part of the process. Unfortunately, it’s not a piece that often gets a lot of attention.

Many times, self-funded employers focus on the surgical costs or injury costs or some other realm of their existing healthcare needs. Pharmacy benefits typically get tacked on at the end of the conversation or companies simply go with the PBM their broker picked.

But one of the key aspects of the self-funded model is choice, and you deserve a choice in your pharmacy benefits plan. And you deserve a partner who will sit down and talk through that plan with you to help you understand every aspect of it.

When evaluating PBMs, here are some important questions to ask.

What are your top recommendations for controlling pharmacy costs?

There could be a wide range of answers to this question, but one of the first things should be looking at your healthcare data and customizing a plan for your needs. There are lots of layers to a pharmacy plan, and it’s important for a self-funded employer to understand all of them and know which ones offer them the best opportunity to reduce costs.

How do you add value to our plan?

There’s a lot of focus on unit cost when it comes to pharmacy benefits. But if you’re constantly driving to the lowest unit cost, there’s a good chance you’re getting low value too. Be sure to ask prospective PBMs about how they add value for you and your employees within the plan.

What programs do you have in place to ensure our employees receive the treatment they need?

Yes, the total cost of your prescription benefit plan matters, but so does taking care of your employees. When talking with prospective PBMs, be sure to talk about programs that support employees who need complex or specialty medication treatments. 

What sort of customer support exists for us and for our employees?

The pharmacy industry is constantly changing with new medications and new pricing. You need a PBM who keeps you updated on any changes that might affect your plan and helps you make adjustments along the way. And if your employees have questions about their benefits, they need a team who can help them with their questions too.

Can we see the contracts you have in place for rebates and pharmacies?

If a PBM won’t show you their contracts, they’re not really a transparent PBM. Reviewing those contracts can help you better understand where your costs are coming from and why.

When it comes to choosing your PBM, don’t let it be something that they slide across the table without giving you a choice. Explore your options and ask lots of questions to find the PBM that’s right for you.

If you’re interested in learning more about how MaxCare is a different kind of PBM, contact us today. We’re happy to chat and answer your questions.