Jim’s Take

This story is told on the accompanying video, or you can read it below.

OK, there’s no such verb as “Rx,” but it kinds looks like an insult or not-so-good thing, so I couldn’t resist.

If you have a health plan, and if you are with the typical Pharmacy Benefit Manager (PBM), then you’re probably getting Rx’d or hosed or taken over the coals or whatever euphemism you want to use.

In fact, I have a list of 32 ways your PBM can take you to the cleaners, and I’ll expound on them over time … because there is a better way to do things.

How big in impact does Rx fleecing have?  Well, divide your annual premium by 4.  That’s about how much you spend on prescriptions.

There are marketing “incentives” given by drug manufacturer to PBMs in order to have them promote or favor their brand of drugs.  Here is a summary of the outcomes from an analysis we did.  This is a bit more percentage savings than I usually see, but not that much more.

Three options, three ways to save.  The current PBM is one of the big three (CVS Caremark, Optum Rx or Express Scripts) offered by a self-funded plan from one of the big Massachusetts carriers (BCBS, Harvard Pilgrim or Tufts), so one would think that the rates and credits they negotiate would be the best.

WRONG!  Take a peek at how to get 20-40% savings:

Want to see if we can do the same for you? Write me (jedholm@bbibenefits) and say, “Jim, fix my Rx!” But give me your contact info.