Pharmacy Benefit Contracts Are Complex and Must Be Monitored

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Crawford Advisors, LLC Monitors Client PBM's to Ensure Effective Administrative Oversight and Plan Savings

Benefits Consulting, Administration & Compliance Experts

Crawford Advisors, LLC

Crawford Advisors routinely performs a pharmacy bill audit, to ensure that the PBM is administering its contract correctly.

An October 2013 Fortune Magazine article entitled "Painful Prescription" discusses how Meridian Health Systems, a non-profit which operates six hospitals, realized significant prescription cost increases after contracting with Pharmacy Benefit Manager (PBM) Express Scripts in 2009. This is one example of how and why PBM contracts must be closely monitored. Crawford Advisors understands the opportunities and responsibilities of PBM administration, and continually assists clients with this challenging task, to ensure efficient plan administration and optimum PBM savings.

The article discusses “spread pricing”, where a plan sponsor is billed one amount for a prescription, and the PBM then reimburses the pharmacy a lower amount, resulting in a profit to the PBM. An example provided in the article noted a “spread” of $65.62 on just one prescription. With an average member utilizing about seven prescriptions per year, this could result in considerable extra expense to the employer. Meridian has since terminated its contract with Express Scripts. In turn, Express Scripts responded that these allegations by Meridian were an anomaly.

Crawford Advisors has significant expertise in working with PBMs, analyzing and negotiating contract terms that are beneficial to a plan sponsor’s long-term prescription costs. Reagan Crawford commented, "Many of our clients carve out their pharmacy benefit to a PBM, and are able to enjoy significant savings compared to leaving the pharmacy with their medical carrier. Crawford Advisors routinely performs a pharmacy bill audit, to ensure that the PBM is administering its contract correctly." Organizations seeking to reduce pharmacy benefit costs, or considering a pharmacy benefit carve out, should contact Crawford Advisors to learn more about its proprietary approach to pharmacy benefit analysis.

About Crawford Advisors, LLC

Crawford Advisors is one of the nation's largest and best-equipped full-service benefits consulting and brokerage firms. The firm has invested heavily in technology to ensure its expert team can provide sophisticated solutions and comprehensive services to furnish the best value for each company’s health and welfare benefits. Crawford Advisors consultants help manage cost, improve the health and productivity of client employees, and add to client companies’ bottom line. Call 800-451-8519 or visit crawfordadvisors.com.

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Carol Smith
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