A PBM may tout how many dollars you can receive due to their rebate program, but is that a good thing? Maybe, it depends.
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Many PBMs place drugs on their formulary or preferred drug list because of the rebates they get paid from the manufacturer. In some cases, this could be good and a savings for the Rx Benefit plan, but many times it results in the plan and the member paying more for medications with no clinical advantage.
For example, cholesterol-reducing drugs like Livalo® that can cost about $750 for a 3-month supply versus generic atorvastatin at $25. Clinically there is no major difference in effectiveness. It’s like having a choice between two similar cars. Both can get you to work but one costs $20,000 and the other one costs $600,000.
Unfortunately, there are many (like over a hundred) similar examples like this. Imagine how much more you may be paying?
Working with the right Pharmacy benefit Consultant can help you identify these situations.