PBIRx Growth Fueled by Johnson & Johnson ERISA Lawsuit
24 Abril 2024 - 1:35PM
Business Wire
A message from PBIRx Founder &
President
A message from PBIRx Founder & President, Patricia Sirowich:
PBIRx is a consulting and auditing firm totally focused on the
pharmacy benefit for over thirty years. Concerns of pharmacy
benefit mismanagement resulting in higher premiums, copays,
coinsurance, drug costs, deductibles, and lower wages or limited
wage growth caused one employee to allege a fiduciary breach in a
75-page lawsuit against Johnson & Johnson.
Self-funded ERISA plan sponsors and their benefit advisors are
engaging PBIRx for our guidance to prevent their clients from being
in a similar situation. There is a major focus on the exorbitant
generic costs and especially Specialty generic drugs. Plan sponsors
must demonstrate that there has been due diligence in evaluating,
selecting, and monitoring of their PBM partner to ensure they are
meeting their fiduciary responsibilities. The facts shared in this
lawsuit have attracted multiple concerned mid to large size self
funded Plan Sponsors to PBIRx and our all-inclusive pharmacy
benefit consulting and auditing services.
PBIRx is one of the first “independent” pharmacy benefit
consulting firms that not only prefers PBMs that offer
transparency, but also allow PBIRx to audit our clients’ PBM
pricing, rebates, clinical programs, and service level performance
measured to contractual guarantees. We are the only consulting firm
that requests a PBM contract with the Proposed financial model
stated in the RFP with calculation methodology for each financial
guarantee along with a repricing file. As an example, the generic
price guarantee can be different from what is stated in the
proposal, different than the repricing file, and different than the
contract language, which forces the PBM to recognize that PBIRx is
an experienced, knowledgeable, and detailed consulting firm. PBIRx
is not a PBM, coalition, or optimizer, and fully discloses all
fees.
Every client has different needs and cultures. PBIRx listens to
and confirms with every client to be sure that there is a clear
understanding of their pharmacy benefit strategies. It is well
known that the top three PBMs are owned by or own an insurance
company and as public companies are beholden to their stockholders
and not necessarily the client. Yet even with that, some larger
companies tend to want to work with the top three even though they
know they will be paying more than they would with a mid-size
transparent PBM.
Another example is that 90% of the time traditional and
specialty generic drugs are lower in cost through the retail
pharmacy if your PBM agreement has been negotiated with competitive
guarantees. Specialty generics can be outrageously higher through a
specialty pharmacy unless your consultant understands, negotiates,
and audits specific guarantees. One word missing in the contract
can cost a Plan Sponsor, depending on the size of the plan,
hundreds of thousands of dollars or more.
Plan Sponsors should routinely have their pharmacy benefit
contract and claims audited by an experienced pharmacy benefit
auditor like PBIRx to ensure that contractual guarantees have been
met and identify areas of improvement.
About PBIRx Our mission is to create optimal healthcare
outcomes while minimizing overall healthcare costs. PBIRx is not a
PBM. Since its founding as the first pharmacy benefit consulting
and auditing firm in 1993, PBIRx has saved clients over $381
million, combating excessive profits of PBMs and pharmaceutical
manufacturers. As a client advocate and educator, PBIRx’s primary
goal is to manage pharmacy benefit costs for clients with a major
sensitivity to their diverse cultures and needs. Our deep knowledge
and advanced tools have helped us build lasting relationships and
empower our clients to unravel the complexities of the
ever-evolving pharmacy benefit industry. We are proud to be
recognized as an Inc. 5000 fastest-growing company, a SOC 2 Type 2
certified company, and a certified Woman Owned Small Minority
Business Enterprise.
To learn more, please visit PBIRx.com and follow @pbirx on X or
PBIRx on LinkedIn.
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version on businesswire.com: https://www.businesswire.com/news/home/20240424130432/en/
For more information contact:
David Sirowich Executive Vice President 203.882.1188 x207
dsirowich@pbirx.com