July 13, 2021

(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) today announced a set of industry principles that outline how pharmacy benefit managers, PBMs, interact with employer clients and other prescription drug coverage sponsors to provide clear, transparent contracting and deliver affordable pharmacy benefits.

“These principles reinforce the industry’s commitment to PBM interactions that empower employers and plan sponsors with clear terms, tools for lowering costs, and choice in designing contracts to best serve their needs and the needs of the patients they represent,” said JC Scott, PCMA President and CEO. “PBMs are committed to the highest standards of excellence in business and contracting practices.”

The PBM industry commitment adheres to the following principles:

  • Negotiating unambiguously with clients all contractual and financial terms, pricing arrangements that achieve clients’ goals, performance monitoring, audit rights, and other tools to improve the affordability of drug coverage and patient outcomes.
  • Delivering lowest net drug costs.
  • Providing actionable, meaningful, and transparent information about prescription drug costs as outlined in the contract, including how much clients pay for each prescription filled by an enrollee in their plan, enrollees’ drug utilization, and rebates and discounts.
  • Describing client-related revenue streams clearly.
  • Using independent clinical experts to develop formulary, clinical programming, and medical management recommendations for clients that promote high-quality and cost-effective patient access to clinically appropriate treatments.
  • Helping clients provide actionable, meaningful transparency to patients that helps reduce prescription drug costs, including what drugs are covered and on what formulary tier, what pharmacies are in the network, and expected costs for their prescription.

    Helping patients and providers understand the client’s formulary, clinical programming, and medical management selections.

  • Offering plain-language explanations of patient appeals processes to support timely therapy initiation and clinically appropriate use and adherence.
  • Offering financial guarantees and service level commitments.
  • Where available, offering pharmacy network options that include high-quality, credentialed, and value-driven pharmacies, including preferred pharmacy networks, specialty pharmacies, and mail-service pharmacies.
  • Where available and selected by the client, describing use of accumulator, maximizer, and/or specialty drug assistance programs.
  • Where used, describing use of third parties for the procurement of rebates.

Along with these industry principles, PCMA also released a series of videos showcasing the value PBMs provide employers.

  • One video features Christopher Goff, CEO and General Counsel of Employers Health, an organization that helps plan sponsors deliver access to high-quality health benefits at a sustainable cost. Employers Health has more than 250 clients representing approximately 400 organizations in 34 states. In the video,
    • Mr. Goff outlines how employers have the choice of selecting a pass-through or spread contracting when designing their prescription drug benefits.
  • Another video highlights Barry Sloane, CEO of Newtek Business Service Corporation, a business development company that helps small and mid-size businesses run their operations. In this video, Mr. Sloane discusses how PBMs help his company reduce costs and improve access to care.

A national survey of benefit managers and human resources directors from North Star Opinion Research found that the vast majority say that programs implemented by PBMs are effective at reducing drug costs for their organization. Overall, more than nine in 10 (93 percent) are satisfied with their PBM, including more than a third who are “very satisfied.”

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs).  PBMs administer prescription drug plans for more than 266 million Americans who have health insurance from a variety of sponsors including:  commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, Medicaid plans, and others.