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.

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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.

There's a long list of reasons why data ownership is a must, but these three should be enough to convince any employer to take action:

  • Enhanced plan performance. Data helps you find opportunities to cut costs without affecting quality, enhance engagement, and more. The insights you gain will put employers and brokers down the path to building a better pharmacy benefits experience for employees.
  • You save money by not paying extra for what's yours. When you own your data, you won't pay a PBM's high fees for access. And there's no tracking down data just to ask a third-party to audit it. The results: a much smoother audit process and better cost outcomes.  

Blockchain could be the answer

To fully free data, a pharmacy benefits program built on blockchain may be the answer. This technology eliminates the need for third-party intermediaries, streamlines complicated processes, and offers control over information, which provides trust that the information is accurate. Because blockchain tracks every record, the technology is auditable in real-time. That means no more painful pharmacy benefit audits. And by offering the added advantage of data ownership, plan sponsors save money. For these reasons and more, a blockchain-based platform that connects employers, insurers, pharmacies, and consumers, stands to replace the costly, centralized reimbursement model we know now. 

Changes are coming

As the FTC works to pull back the curtain, industry-wide enhancements are expected to follow. Transparency will improve, technology will continue to advance, and your data will tell a more complete story. This all means more trust, more choice, and more control, for you and your entire staff. The ultimate goals: happier employees and better health outcomes at affordable costs. Anything less means the "big three" still hold too much power.

Andrea Pickett is Chief Customer Officer at Prescryptive Health, Inc. 

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