Pharmacy Benefits Management (PBM)

The goal of our pharmacy benefits management (PBM) program is to provide plan participants access to affordable medications used to treat chronic diseases and acute diagnoses. Since 1995, our collective strategy for Rx benefits has a proven track record of delivering aggressive financial performance for Employers Health members. By engaging with best-in-class suppliers – CVS Caremark and OptumRx – the Employers Health PBM program provides market-leading pricing and terms, while protecting each plan’s unique features. Through 2016, the PBM program:

  • Has approximately 170 individual plan sponsors headquartered in 33 states
  • Covers approximately 700,000 lives in all 50 states, the District of Columbia, Puerto Rico and Guam
  • Collectively spends more than $1 billion on pharmaceuticals

The realized savings over time is greater than most plans can achieve on their own. Plan sponsors get the most from the PBM relationship, while implementing their own plan design strategies, managing vendors or working through established consultants.

In addition to exceptional customer service and account management services, participating members tell us they value:

  • Clinical oversight: Members benefit from a staff pharmacist who regularly provides information on topics such as new drugs, generic launches, plan design strategies and overall trends based on actual plan data. At no additional cost, members benefit from first-hand knowledge and having their best interest represented with vendors.
  • Plan Oversight: A dedicated Account Management team is readily available, and acts as an extension of the benefits team working with vendors to assist with acute issues to managing more complex scenarios like performance guarantees.
  • Contract Oversight/Audit: With three staff attorneys, members rest assured that all contractual obligations and legal aspects of vendor contracting and auditing are covered. All recoveries as a result of a no-cost independent third party audit are passed back to the appropriate plan sponsor. Additionally, plan sponsors appreciate the ability to connect their legal department with the Employers Health legal team to answer questions and work through negotiations.
  • Data Analytics/Reporting: In addition to reports from vendors, members benefit from objective ad hoc reports to help interpret plan performance metrics. Members are also able to receive assistance with reviewing projected budget numbers or advice on plan design changes.
  • Networking & Learning Opportunities: There is much to be learned from colleagues and peers. One of the most mentioned added benefits of membership in Employers Health is the opportunity to engage with, share and learn from other like-minds. Members benefit from dozens of opportunities to do this each year.
  • Added Benefits: As a leading employer-led purchasing coalition, members have access to benefits that most direct-to-vendor relationships are unable to leverage. The team at Employers Health helps facilitate these relationships and looks for every opportunity to bring added value to the equation.

Interested in our leading PBM program? Send us a message here!

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