"For certain types of drugs with complicated handling or administration needs, called “generic-specialty” medications, the company’s health plan on average paid about six times as much on average as the pharmacy benefit manager paid, the complaint alleges."
This would never happen with our PBM solution, Drexi. Our contracts are solid and don't wordsmith in a way that is complicated, unclear and detrimental to the employer and its members. When defining a Generic, many PBMs like the one J&J is partnering with use broad language so that situations like this can happen....and they do all of the time - this is not a one-off situation in the slightest. I have a new Drexi case where we saw this same example in the data with their former PBM. The numbers were not as egregious like this example of ~$40 vs. $10K! But it was a $4000 price that should have been ~$100. And it was a "Specialty-Generic".
Our PBM can save upwards of 45-50% on pharmacy claims. That is significant! With the huge spikes in costs and the expectation that there is a lot more to come in the future (some stating pharmacy spend will soon surpass medical), we would love to offer a complimentary analysis to show a prospective client how we operate and the significant savings that we can bring - along with a unique and powerful tool for members!
https://lnkd.in/gYq42Pw9
