Transparency is a buzzword when it comes to Pharmacy Benefit Managers (PBMs). Many people are talking about the rising prescription drug costs and the transparency that PBMs provide.

PBM Transparency: What you need to know

PBMs were created on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers to help manage prescription drug benefits, reduce administrative costs for insurers, administer plan benefits, and negotiate costs between pharmacies and health plans.

In recent years, PBMs have been getting a lot of attention around being transparent. However, in the pharmacy benefit management industry, there are different definitions of what transparency means.

Yes, unfortunately, it is true.

If you talk to one PBM about their definition of transparency, then all you have is one definition of transparency. The definition widely varies from one PBM to another.

In the PBM world, transparency has many shades to it and there are PBMs that exist along that spectrum. Examples of this include:

  • Partial disclosure of spread-pricing
  • Limited audit rights,
  • Additional fee sources

What definition of “transparent” is your PBM using? Does it match your definition? A contract review can help align expectations and establish true contractual transparency. Click here to contact one of our experts to see how we can help.