Increase PBM Savings with Pharmacy Benefit Administration Services

April 28, 2021

Plan sponsors have long recognized the value of a Pharmacy Benefit Management (PBM) program for generating significant savings. According to the latest 2020 data from Pharmaceutical Care Management Association (PCMA), PBMs save employers and patients $100 billion per year on prescription drug costs. Viewed another way, PBMs save employers and patients $625 per enrollee per year on prescription drug costs. Can employers and individuals, however, gain even more from their PBMs? The answer is “yes” with the support of a Pharmacy Benefit Administration (PBA) Service.

Thermometer over a pile of white orange and green pills

What is a Pharmacy Benefit Administration (PBA) Service?

Provided by a third party administrator (TPA), a PBA service provides valuable support to both plan sponsors and members regarding their PBM program. A PBA essentially operates the same as a PBM with more flexibility in accessing data, reporting and pricing. Specifically, the TPA gives access to various online tools that enable easy access to drug and health-related information. Through a PBA online service platform, members can obtain prescription refills, receive refill prescription reminders and learn more about the drugs they are taking through various online information tools, such as videos and product descriptions.

How Does a PBA Help Contain High Specialty Drug Costs?

As plan sponsors already know, specialty drug costs have been escalating at an unprecedented rate. In America, per capital drug spending on specialty drugs have been steadily increasing. Between 2013 and 2016, this spending increased by 55% with the average costs of a specialty drug now at $4,500 per month according to the Express Scripts 2018 Drug Trend Report. These costs can be reduced when a PBM program is backed by a PBA service. An added advantage is in the subsequent limiting of stop loss liability.

A New PBA Delivering High PBM Value

Recently, Amalgamated Employee Benefits Administrators, one of the nation’s leading TPAs for unions, businesses, associations, and self-insured plans announced its launch of a new PBA service – AEBRx. This union affiliated, innovative, end-to-end PBA service focuses on helping plan sponsors effectively manage high-cost specialty drugs while delivering excellent service and access to a national network of retail pharmacies with mail order capabilities. In providing AEBRx, Amalgamated Employee Benefits Administrators is partnering with Magellan Rx Management, a full-service pharmacy benefits management division of Magellan Health, Inc.

Using AEBRx, Taft-Hartley trust funds and plan sponsors will have the opportunity to realize significant cost savings from the standard inclusion of both the Payer Matrix and ELMCRx Solutions’ Tesser Health programs. These two programs work in conjunction to create an advanced specialty drug cost management program and specialty drug prior authorization service that results in an average savings of 40% in addition to containing medical stop loss liability.

AEBRx offers a user-friendly, easy to navigate platform powered by Magellan Rx Management. It features visually engaging dashboards, intuitive functionality, and real-time data that is readily accessible online. Robust tools connect plan members on a 24/7 basis to drug and related healthcare information from their mobile devices or desktops. Using AEBRx’s responsive member portal and quick response (QR) codes on select specialty prescription labels, plan members can easily access information and medication videos on demand and obtain refill reminders with real time alerts.

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