Health Action Council recently completed an extensive, year-long, member-driven pharmacy benefits management (PBM) RFP process that followed public procurement guidelines. The Board of Directors approved OptumRx and CVS/Caremark's renewal, and the finalized contracts feature competitive pricing, innovative pricing models, and improved rebate payout cycles.
>Download more information about OptumRx pharmacy program
>Download more information about CVS/Caremark pharmacy program
Highlights of new PBM group-purchasing contracts include:
- Innovative pricing. A new pricing model, NADAC, is very transparent and aligns drug prices with drug acquisition costs rather than manufacturer list price.
- Open-sourced. Plan sponsors have access to their data and the contract terms and conditions.
- Commitment to quality. PBM partners will continue to study new ways to add value for patients, plan sponsors, and providers.
- Improved rebate payout cycles. Plan sponsors receive rebates on a quicker timeline.
Health Action Council offers members the opportunity to participate in their PBM program that saves money and includes members in the arduous and expensive RFP process to ensure they get the most desirable results.
Recent results from Health Action Council’s group purchasing prescription drug program include:
- $130 million in pharmacy audits and market check savings from 2013 – 2021
- Single-digit percentage pharmacy trend for 18 consecutive years
- $40.6 Million in pharmacy market check savings over the last two years
The advantage of a group purchasing PBM agreement.
Health Action Council goes through a member-driven procurement process where members weigh in on what is essential and what they are looking for in a partner.
"We are accountable to our members and responsible to them" said Kevin Gregory, Vice President, Business Solutions. "Our members are involved in every step of the way – from sending in RFP questions – voting on who the finalists are – and grading them. The final vote for who will be the endorsed vendors has everything to do with members,” said Gregory.
>View our list of current members.
Besides conducting a complete pharmacy benefit manager RFP regularly, member groups also receive independent PBM audits and market checks at no cost. It is not cost-effective or administratively feasible for employers to conduct independent audits and market checks every year, so Health Action Council does the work for them. Currently, Health Action Council is celebrating 18 consecutive years of single-digit or negative trend.
Aaron Graham, Business Solutions and Innovation Leader, explains that the members met every month from February through July of 2020.
"There were a lot of opportunities for members to weigh in and get involved", said Graham. "We are constantly educating members as well – we recently did a webinar on managing costs for specialty drugs – we want people to have a bigger understanding of pharmacy management rather than just signing up for a program and going into it blindly.”
Health Action 'Council's earnest desire is to stay ahead of the curve to ensure that members are getting the best prices possible and terms that support employees' overall health.
If you'd like to learn more about Health Action Council's PBM Program, please send us an email or call 216-328-2200.
About Health Action Council
Health Action Council is a not-for-profit 501(c)(6) organization representing mid-and large-size employers that enhance human and economic health through thought leadership, innovative services, and collaboration. It provides value to its members by facilitating projects that improve the quality and moderate the cost of healthcare purchased by its members for their employees, dependents, and retirees.
Health Action Council also collaborates with key stakeholders – health plans, physicians, hospitals, and the pharmaceutical industry – to improve healthcare quality and efficiency in the community. For more information, please visit www.healthactioncouncil.org.