The American Psychiatric Foundation reports that employers’ expenditures for mental illness and substance abuse fall within 80 to 100 million dollars. Such illness, according to the foundation, is a non-discriminating medical condition that affects people regardless of age, gender, position or race. In its campaign for “Partnership for Workplace Mental Health”, it advocates for a healthy workforce. Accordingly, it is linked to lower medical costs, increased employee productivity and avoidance of absenteeism. The foundation calls for companies to review their health plan and find out what their pharmacy benefit manager (PBM) is doing, among others.
Who are Pharmacy Benefit Managers (PBMs)?
PBMs are often bundled with medical insurance benefits that the private company gives to its employees. They manage company employees’ prescription drug insurance coverage. They decide where Americans can get their prescriptions filled. They assure that high-quality drug care at the lowest possible cost reach the doorsteps of its clients. They handle:
- Processing of pharmacy claims
Processing of claims and follow up is major PBM task.
- Mail-order pharmacies
It promises an accurate prescription filing and home delivery.
- Building pharmacy networks
This network gives consumers convenient access to prescriptions with more discounted rates.
- Management of formulary
The formulary is a list of drugs that will be covered in the policy. It helps control drug costs in a number of ways. First, it encourages the use of formulary drugs through compliance programs by giving information to clients and physicians about the listed drugs. Secondly, it limits the number of drugs a plan will cover. Lastly, it gives financial incentives to encourage the use of formulary products that benefit most the patients.
In addition to all these, PBMs also conduct negotiation of rebates with drug manufacturers, do prospective and retrospective drug utilization reviews (DURs), find generic drug substitutes, and disease management programs and finally conduct an audit pharmacy.
With a PBM, the company’s workforce health is taken care of.