To Regain Control of Drug Costs, Health Plans Must Understand the Road They've Traveled

Gregory S. Kaupp, JD, MPA, MLT, and Scott B. Lynch, JD

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Time to Reintegrate

For Medicare to not find itself in the same dilemma as today's health plans, any legislation passed should require a firm fire wall between the provider and the claims portions of the drug benefit management process. This will provide disclosure of benefit management practices that, in turn, will reassure Medicare beneficiaries and the public at large.

In order for health plans to control drug costs today, they need to begin to bring some of these services back in-house and ask for full disclosure of PBM revenues. This means that during the next few years the current PBM business model must evolve to return the strategic and operational control of benefit administration to the health plan. Prescription drug therapy is not a stand-alone benefit. Helping people manage chronic illness and navigate the complexities of the modern health care delivery system requires an integrated approach to health benefits. Wise health plans and employers will discover that reintegration of the pharmacy benefit with the rest of the health benefit will provide a more effective long-term solution to the rising cost of prescription drug therapy.

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