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Pharmacy Benefits Manager on Your Side

Are you getting the most out of your employer-sponsored pharmacy benefits? From pricing terms and contracts to understanding clinical programs, you need a Pharmacy Benefits Manager (PBM) who is looking out for you.

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Why Should You Have a Pharmacy Benefit Manager?

  • Industry Opaqueness
    Understanding the complexities of the pharmaceutical industry can be hard. With increased drug costs and supply chain disruptions, companies must find a solution to providing affordable and effective healthcare benefits to their employees.
  • Role of a Pharmacy Benefit Manager
    With 60 Pharmacy Benefit Managers (PBMs) in the industry, it’s challenging to consider which PBM, if any, to do business with as an employer. A PBM’s role is to manage drug benefits on the behalf of health insurers, large employers, and other payers. This is where Holmes Murphy can help.
  • We Strive to Understand.Fully.
    We lean in to understand you — your employee population and business — by offering consistent, high-quality consulting services tailored to your specific needs.
Get the Full Write-Up on Holmes Murphy’s Pharmacy Solutions

You need a pharmacy strategy to ensure all aspects of your pharmacy benefit — from pricing terms and contracts to clinical programs and drug utilization — are aligned to stretch your pharmacy dollar. How do you get there? 

At Holmes Murphy, our experts are equipped to help you control pharmacy spend as it continues to grow at record paces. In the past, employers have traditionally depended on their insurance brokers to unite the carrier, third-party administrator, and Pharmacy Benefits Manager (PBM) to provide a solution for handling their pharmacy expenses. While this approach might have been effective previously, it’s not sustainable for the future.  

What You May Not Know About Pharmacy Benefit Managers 

A PBM must find ways to extract additional revenue from existing customers to grow, meaning they could overcharge their existing customers to expand their business or profit margins. This is the problem with the structure of most PBM relationships today. Financial gain and not clinical effectiveness drive formulary placement.  

This lack of transparency and complexity in the pharmaceutical sector is concerning for employers. That’s why having a dedicated PBM expert who understands the industry’s nuances is crucial for protecting plan sponsor benefit spend, and that’s where our expertise lies. At Holmes Murphy, we bring the right partners to the table to deliver consistent, high-quality consulting services throughout the year, ensuring peace of mind while presenting cost-effective spending alternatives. 

We focus on areas, including: 

  • High-cost infusion products administered under the medical benefit 
  • New-to-therapy treatment options 
  • Manufacturer co-pay assistance programs 
  • Definitions 
  • Audit language 
  • Claims inclusion in performance metrics 
  • Exclusivity on mail order and specialty drugs  

Our goal is to help you understand your current pharmacy contract, identify ways to reduce cost, and ensure the contract is the right fit for your organization. 

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