By: Maria Williams
The US health insurance and prescription medicine industry is often criticized as complicated and dysfunctional due to the high costs and numerous parties involved. Pharmacy Benefit Managers (PBMs), who are third-party administrators of prescription drug programs for employers and health plans, are often blamed for contributing to the high costs due to the lack of transparency. While, on paper, PBMs are supposed to negotiate discounts on the prices of prescription medicines, many PBMs hide costs behind proprietary networks and complex pharmaceutical contracts. These can result in an inflated cost of medicines, putting customers at a disadvantage.
One PBM is going against this, seeking to bring more transparency into the industry. Scripius is part of the nonprofit health plan Select Health, which operates in Idaho, Nevada, Colorado, and Utah, and is a subsidiary of Intermountain Health. According to Scripius, most PBMs lease part of their network and rebate contracts, so they are unable to provide total claim-level data because they are contractually forbidden from sharing third-party contract details.
In contrast, Scripius owns its entire pharmacy network and rebate contracts, allowing it to share additional and transparent details with its clients. Its commitment to transparency ensures that clients get lower net costs in prescription medicine management.
Eric Cannon, General Manager of Scripius, says that the typical PBM contract has more than 200 pages. Meanwhile, Scripius’ contracts are around 30 pages long and contain simpler terms and language that is easier to understand. This emphasizes the company’s commitment to transparency and its mission to steer the industry away from the opaque and confusing status quo.
“Today, the cost of pharmaceuticals is bolstered by the lack of transparency that exists in the market,” Cannon says. “We’ve found that, by providing clarity and transparency, we can reduce the overall cost of prescription medication by 15% to 20% for our clients. That comes in the form of discounts, and also in the form of utilization management, by controlling and improving what’s purchased and how it’s purchased, as well as what’s used and when it’s used.”
Scripius has established contracts with numerous pharmaceutical manufacturers and pharmacies across the US, serving a significant number of individuals through their employers or health plans. Scripius facilitates a more transparent flow of information among all parties involved, including patients, doctors, and pharmacies. Supported by Select Health and Intermountain Health, two major players in the Western United States, gives Scripius longevity and durability in the market. Last year, Select Health and Scripius partnered with Mark Cuban Cost Plus Drug Company, providing Select Health members direct access to the groundbreaking prescription drug service.
“Having worked in the pharmacy industry for decades, I was frustrated with how the system would inflate prices, leading to consumers getting the short end of the stick,” Cannon says. “At Scripius, we can help change what’s happening. We are driven by the fact that there is a need for transparency in PBM services and we have a solution that will work.”
Published by: Khy Talara
