The Case for a National Pharmacy Benefit Management Program
Many school districts self-insure their employee’s pharmacy benefits. The financial performance of these plans has a direct bearing on the ability of the school to educate children and pay staff and teachers. Unlike many other aspects of health benefits prescription drugs are a pure commodity, to be purchased at the lowest possible costs. The advantages of large group purchasing on a national scale coupled with the ability of NSBA to provide an industry leading contract offers member school districts the ability to confidently make the purchase of prescription drug benefits at the best possible cost and in the safest possible manner. The following information is meant to explain why the offer of a national program through NSBA is in the best interest of school boards everywhere.
How Pharmacy Benefit Management Companies (PBM’s) Operate and
The Benefits of the NSBA School RX Cooperative
The difference in costs is a function of a marketplace that is driven by the desire of the PBM’s and oftentimes health plans to offer the least attractive terms possible so as to maximize their own profits and revenue streams. To protect schools from excessive costs they should consider a program like the NSBA School RX Cooperative which only cares about driving the lowest possible costs for its members. In most cases NSBA will reduce pharmacy costs from 10% to 25% with no required change in benefits.
Recognizing this lack of regulatory oversight, NSBA has created a pharmacy benefit management program that serves to act as the eyes and ears of the schools to assure that all that can be done to protect their interests is being done.
The contract that NSBA offers to schools was not created by the PBMs but by industry leading experts with the sole goal in mind of making it as school friendly as possible both today and into the future. These experts have the actuarial, underwriting, and clinical expertise to be able to assure member schools of the best possible oversight of all aspects of their PBM experience. They continue to support the NSBA program on a full-time basis and are dedicated to managing the pharmacy benefit contract, so that no changes in contact language can be added that are not in keeping with the best interests of the schools.
The NSBA contract provides schools with discounts and rebates equal to those offered to the largest employers in the country. By working with a very large pool of covered people NSBA’s contract is much more cost effective than what most individual schools, or even regional consortiums of schools, could hope to achieve on their own.
NSBA will provide participating schools with the financial terms of the program whenever requested; however, because of the highly unique nature of the NSBA contract and the need to keep the proprietary terms of the contract secure a Non-Disclosure Agreement must be executed by the school and a high level of due diligence exercised to keep the financial terms and contract language confidential.
The NSBA program is a two-year contract with a comprehensive market check on the off years. As a result, the vigilance and negotiation of the terms and pricing elements is continuous so that schools are constantly receiving enhanced benefits from the program. Over the last 6 years, the program has increased savings every year because of this approach and all participating schools receive these savings immediately, they don’t have to wait for a contract renewal.
The NSBA program is supported by hundreds of thousands of covered members so that the pricing is competitive with the largest employers in the country – far better than what individual schools or groups of schools might be able to negotiate on their own.
PBM claims audits performed by a professional, independent, third-party auditing firm will typically cost thousands of dollars. The NSBA program includes a third-party auditing program that audits 100% of all claims, by school, and reports to each school quarterly. The cost is borne by the PBM even though they have no hand in the audit process itself.
The NSBA program is a “carve-out” program meaning that each school has its own contract and receives the complete executed contract for its records. All the schools in the NSBA program have identical contracts. Because of the self-funded nature of the program, the schools have the right to all claims data in formats that do not jeopardize the confidential nature of the proprietary terms of the program.
The NSBA program offers a clinically based management program to the schools that works with the claims data to identify situations where patients are taking medications that are more expensive than other equally effective drugs that are available at less cost. Physicians and pharmacists reach out to the prescribing physician in a collegial way to see what might be done about moving to the less expensive drug. The program has proven very effective and carries with it a guaranteed minimum return on investment.
The NSBA program protects the schools in this regard by fully disclosing the management fee that the schools pay for the services provided by the program. Other than the fees paid by the PBM to the independent auditing company, no one associated with the NSBA program – not NSBA, nor the plan services manager, nor anyone else – receives any compensation of any kind from the PBM or the Pharmaceutical industry. This keeps the NSBA program free of any undue influence because of inappropriate payments. Should a school wish that a particular consultant or broker be compensated that can be arranged but it will be fully disclosed and paid by the school.