The Federal Trade Commission is pushing PBMs for greater transparency in an effort to help employers take control of their prescription costs. But what is transparency without access to plan data or performance analytics? Currently, employers are disempowered because too many don't own their data, have to pay extra to get access to what should already be theirs, or only receive partial access. These PBM practices of obscuring data have led to significant distrust from all stakeholders. To fix a broken system, the data being hidden by these third parties needs to be freed to provide employers and plan members with the information they need to find the path to lower costs. 

Putting pressure on the "Big 3"

The FTC recently launched an investigation into the anti-competitive practices of the major pharmacy benefit managers. The PBMs under the microscope include CVS Caremark, OptumRx, and Express Scripts, who alone control pricing for 80% of the prescription drug market. The long-overdue decision to investigate is a good thing, but does it go far enough? This is the FTC's chance to finally shed light on the PBMs who control drug prices and distort the market. But only time will tell if they focus on the right things and push hard for the right outcomes. Real impact will only happen when employers and their benefits advisors gain the data control and access they need to design a plan that works for their people and their bottom line.

Own your data

PBMs built the current system to keep information obscured while monetizing access to the data for those trying to help solve the problem. Without access, employers are left in the dark about the true cost drivers of medications, rebates, plan utilization, and more. This deceptive approach has a human cost and consumers ultimately pay the price: 1 in 4 already struggle to afford their medications.

But employers and brokers have the power to take more control. To begin the process of liberating data, start by looking at what's in your PBM contract. Does it include any ambiguities regarding the PBM's obligations to act in your best interests? The agreement should be clear that the plan sponsor owns the plan data and that it will be made available to the plan at no cost.

Once you know your current situation, start taking ownership of what's already yours. To avoid any uncertainties, consider these key questions:

• How is the data being managed?
• Who's making money from it?
• If you don't own your data, what insights would you gain if you did? 

Why does it matter?

Owning your data has never been more important, because it means you hold the power to make the right decisions at the right time. For example, plan data holds the keys to knowing whether the plan is delivering a quality benefit at the lowest net cost. The data can also show whether rebate guarantees are really lowering costs or increasing them. The business and health insights data provides can lead to cost savings, utilization improvements, a better benefits plan, and an enhanced employee experience.