Transparency is a hot topic in the healthcare world right now. News articles are talking about pharmacy benefits managers (PBMs) and quoting critics who say PBMs are responsible for the increase in drug prices. Some states are exploring ways to cut out the middleman in hopes of reducing prescription prices and saving people money on healthcare.
But PBMs aren’t always the bad guy. In fact, some companies are presenting a much-needed alternative to that traditional model and offering true transparency in pharmacy benefits, especially as it relates to self-insured companies. At MaxCare, we show our clients everything—pricing structures, contracts with pharmacy providers, rebate levels, etc. Our clients know exactly what they’re paying for and why. That’s true transparency.
While the self-insured model has been around for many years, it’s gaining popularity as a way for companies to better control their healthcare costs. They’re paying for the medical care their employees actually use and not upfront premiums with extensive coverage most employees will never need. The evolving marketplace also includes things like direct primary care physicians and surgery centers with clear up-front pricing.
True transparency throughout the healthcare model benefits the employee, their employees, and the companies involved in providing care. Many people with a traditional insurance plan can remember needing either emergency or surgical care and having absolutely no idea what it would cost going in. Transparency in healthcare changes that. People know up front what a sick visit to their doctor or a surgical procedure or their new prescription will cost them.
With true transparency, employers also know what it’s going to cost. If they’re working with the right PBM, the partnership can help the employer design the benefit plan that works best for their company and their employees. They have a trusted advisor who will monitor their plan and make recommendations for places they can save money while still taking care of their employees.
With all the buzz about transparency, there are many companies claiming to be transparent in their pricing, but it’s not always true. Make sure you’re asking plenty of questions and that your pharmacy benefits manager will share their contracts and pricing so you can make an informed decision.
Want to chat more about MaxCare’s approach to transparency? Give us a call today.