3 Reasons Why It’s Important To Own Pharmacy Benefits Data.

There are several reasons why data ownership is essential, but these three should persuade brokers and employers to take appropriate action.

 

In an effort to aid companies in gaining control over their prescription prices, the Federal Trade Commission is pressuring PBMs for increased openness. But what good is openness if you can’t access performance analytics or plan data? Too many employers do not own their data, pay extra to gain access to information that should already be theirs, or only have partial access, which disempowers them. There is a great deal of mistrust among all stakeholders as a result of these PBM practices that hide data. The data being withheld by these third parties must be released in order to give employers and plan participants the knowledge they require to determine the best course for cost reduction in order to rectify a dysfunctional system.

 

Putting the “Big 3” under strain

The big pharmaceutical benefit managers’ anti-competitive activities are the subject of a recent FTC probe. The three PBMs that collectively control 80% of the price of prescription drugs are CVS Caremark, OptumRx, and Express Scripts. It’s excellent that an investigation has finally been decided upon, but does it go far enough? The FTC has the opportunity to finally shed light on PBMs that regulate drug costs and cause market distortions. But only time will tell if they put the proper priorities first and work tirelessly to get the desired results. Real change won’t take place until companies and their benefits consultants have access to the data they need to create a strategy that benefits both their employees and their bottom line.

 

Own your data

PBMs created the current system in order to conceal information and charge people who want to access it for helping to solve the problem. Employers are in the dark regarding the real cost drivers of pharmaceuticals, rebates, plan utilization, and more if they do not have access. Consumers eventually pay the price for this deceitful strategy because 1 in 4 already struggle to pay for their prescriptions.

The ability to exert more control, however, lies with employers and brokers. Look at your PBM contract as a starting point for the data liberation process. Is there any question about the PBM’s duty to behave in your best interests in it? The ownership of the plan data and its free availability to the plan should both be specified in the agreement.

Once you are aware of your current circumstance, begin to claim what is already yours. Take into account these important inquiries to eliminate any doubts:

• How is data management done?
• Who benefits financially from it?
• What knowledge would you gain if you owned your data if you don’t now?

 

Why is it important?

Owning your data is more crucial than ever since it gives you the ability to make the best choices at the appropriate moment. For instance, plan data can tell us whether the plan is providing a high-quality benefit at the lowest possible net cost. The data can also show whether rebate guarantees are really lowering costs or increasing them. The business and health insights data offers can result in cost reductions, greater usage, an improved benefits package, and an improved employee experience.

There are many reasons why data ownership is essential, but these three should persuade every employer to act:

• An understanding of what you are really being charged. Employers are in the dark about the actual costs of medication, utilization, and other things without plan data. Access and analytics shed light on the information you require.
• Enhanced plan performance. Data enables you to increase engagement, find ways to reduce costs without compromising quality, and do much more. Employers and brokers will be able to develop a better pharmaceutical benefits experience for employees with the help of the insights you gain.
• By not paying more for what is already yours, you save money. You won’t be required to pay a PBM’s exorbitant access costs if you own your data. Additionally, there is no searching for data only to request an audit from a third party. Better cost outcomes and a far more seamless audit procedure were the outcomes.

 

Blockchain may provide the solution.

A blockchain-based pharmacy benefits scheme might be the solution to truly liberate data. With the help of this technology, complicated procedures may be streamlined, third parties are no longer required as mediators, and information can be controlled with confidence that it is true. The blockchain technology is auditable in real-time because it keeps track of every record. Thus, there won’t be any more grueling pharmacy benefit audits. Additionally, plan sponsors save money by providing the extra benefit of data ownership. For all of these reasons and more, the current expensive, centralized reimbursement model may be replaced by a blockchain-based platform that links employers, insurers, pharmacies, and consumers.

 

Changes are coming

It is anticipated that improvements will spread throughout the business as the FTC seeks to lift the veil. Your data will tell a fuller picture and transparency will increase as technology develops. For you and your entire staff, this all translates to greater trust, more options, and greater control. The ultimate objectives are more contented workers and cost-effectively improved health outcomes. Any less indicates that the “big three” still have excessive power.

 

 

 

 

Source: https://www.benefitspro.com/2022/08/31/3-reasons-why-owning-pharmacy-benefits-data-matters/