Pharmaceutical benefit management is one of the most complex and dynamic industries with a well-deserved reputation for hidden agendas. It is this PBM “black box” that gave rise to our coalition when plans and employers realized they needed specialized help in tackling it.

One way the industry has handled the call for increased transparency is by creating a PBM “pass through” model that makes their profit from administrative fees instead of keeping a margin. WisconsinRx/National CooperativeRx has fully evaluated this model for both the coalition as a whole and for specific members that request it. What we have found is for most plans, a pure pass through model is not the highest quality, lowest cost solution, as plans are just paying more on the administrative side.

We take a different approach to transparency – one that ensures our PBM partner still has skin in the game to negotiate their own aggressive rebates but guarantees that our members directly benefit from that effort. Our coalition has not only negotiated an aggressive “per prescription” minimum rebate guarantee, but our contract also obligates our PBM to pass through 95 percent of the rebates it collects. As a not-for-profit cooperative, the coalition returns 100% of the rebates it collects to our members.

Best of all, we retain independent firms that audit every single claim incurred by our member plans. It is the only way we can be confident, and our members can be assured, that they are receiving all of the financial benefits we have negotiated on their behalf. Read more about our claims auditing services.