Leading the charge in the era of PBM shakeups.

Last week, one of the largest health plans parted ways with its long-standing “Big Three”pharmacy benefit manager(PBM). The announcement comes at a time when the pharmacy industry is facing mounting criticism about transparency, accessibility, and affordability.

The catalyst for this shakeup was the health plan’s recognition that legacy PBMs are designed to maximize profits for themselves rather than prioritize quality, cost-effectiveness, and convenience for members. This misalignment prompted them to partner with various vendors, including Mark Cuban Cost Plus Drugs (Cost Plus Drugs) and Amazon, to craft a pharmacy benefits model tailored to their needs.

The news sent shockwaves through the industry, causing many employers to reassess their own PBM relationships and question whether a 'disruption' like this holds the key to solving their skyrocketing Rx costs.

The truth is, this health plan’s approach isn't as groundbreaking as it seems. There are innovative solutions already challenging the shady practices of legacy PBMs. At Rightway, we've built a PBM anchored around transparency that removes complexity and saves our clients an average of >15% on Rx costs in year one. Here’s how we do it:

Rightway delivers unmatched Rx savings.

The health plan claims its new approach will save $500 million, cutting as much as 10% or more of its current spending on prescription drugs. Does this figure fully account for a potential increase in internal administrative expenses? How much will members actually save at the pharmacy counter, as it appears most of the savings are driven by a change in the rebate vendor? And could coordinating multiple vendors with their own personal interests get complicated and expensive? The health plan’s savings estimate is just that- an estimate.

Rightway guarantees savings by unlocking margin trapped in the supply chain and delivering it back to clients and members. Our transparent pricing model drives toward the lowest net cost instead of relying on inflated list prices with hidden rebates and fees. Pharmacy guides identify cost-effective medications for members through generics and mail-order solutions to further drive down Rx costs.

Rightway engages members on their pharmacy journey with pharmacy navigation.

Members struggle to navigate their pharmacy benefits. When they have to choose between vendors or initiate calls to their PBM, pharmacy, or insurer, it leads to significant gaps in care, and they lean on HR teams for help. The health plan’s approach tackles some key pharmacy benefit problems but misses a big one - engaging members across their Rx solutions. The health plan's model is akin to holding essential building blocks but lacking the glue to bind them together.

Rightway's model uses dedicated pharmacy guides to help members navigate the complexities of their Rx journey. Pharmacy guides educate on benefits and answer Rx questions, reducing dependence on HR teams for complicated health concerns. They proactively find savings through partnerships like Cost Plus Drugs and monitor utilization and adherence for better outcomes. Rightway’s member engagement strategy empowers members to actively participate in their pharmacy journey and maximize their benefits.

Rightway simplifies pharmacy benefits management for HR teams.

Building an in-house pharmacy benefits management solution is complex. It requires a robust internal team to handle integration, vendors, technology, and more. It also needs expert pharmacy staff to manage formulary development, utilization management, and contracting. The health plan has an advantage with its current pharmacy teams who know these complex functions. However, most employers lack the large, specialized pharmacy departments and extra resources needed to take this on.

Rightway has already developed a top-tier pharmacy benefits management solution with trusted partners like Cost Plus Drugs and Amazon. We manage key pharmacy tasks, like overseeing core Rx benefit functions, streamlining integrations, assisting during open enrollment, and coordinating vendors to reduce the administrative burden for your teams. With Rightway, employers can achieve the advantages of an in-house pharmacy program without the hassle of having to build and oversee everything themselves.

The PBM industry is at an inflection point. It is finally being recognized that the “Big Three” PBMs are stealing from employers and members. Rightway saw it coming and built a next-gen pharmacy benefits management solution designed to dismantle the traditional model and drive significant savings for both clients and members.

Ready to join in on this wave of PBM innovation? Connect with us.