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In a recent webinar, Alissa Johnson, Director of Clinical Strategy at SmithRx, walks through how cost-based options can significantly lower pharmacy costs for employers. By switching to cost-based PBM models, employers can drastically reduce the cost of high-dollar specialty drugs, like Humira, and improve employee access to essential medications with lower out-of-pocket costs. 🎉 This approach benefits employees, employers, and HR teams by lowering prescription drug costs, reducing legal risks, and improving medication adherence. 👉Watch to learn how cost-based PBMs like SmithRx can transform your benefits strategy? #HR #EmployeeBenefits #PBM #SmithRx #Humira #healthcare

Transcript

We want to walk through some more examples on how cost based options really lead to lower pharmacy costs and where this really makes a big impact. And so if you all look at your drug spend by category, for most employers the top category is autoimmune drugs. So this is drugs like Humira, which is shown here. It is around $118,000 annually. There are different discounts. They're like AWP discount -24% this is the discount at the pharmacy and then the rebate paid from the manufacturers around $55,000, which ends up making the drugs $34,000 a year. However, that $55,000 rebate isn't right away and. If the employer gets most or all of it, they usually have to wait six or nine months to get that payment. And so it's a lot of cash to flow. Whereas in a cost based model there is a biosimilar for Humira called Yoshimori that's only $7200 a year. And there's no waiting for rebates. There's no additional discounts that can be negotiated or anything like that. This is just the flat upfront fee. To lower the cost and so. If the lower if the overall drug cost is lowered that much you can imagine what it does for the member out of pocket. Moving Humira costing around $750 a month to use summary only being around $60.00 a month. Now granted this can change based on how your benefits are built out and what your copay selections are when it comes to high dollar specialty products. So this is where it really can make an impact for your plan. So instead of. Spending something like $100,000 initially you can just spend around 7:00 and another example is a drug for diabetes called Jardiance where it starts at around just under $9000 a year. With again, similar discounts and rebates that. May or may not get paid and may or may not take awhile versus another drug called Brent Zavi that's only $600 a year. It's the same mechanism of action and for the employee impact, rather than paying around $60.00 a month, it's only $5.00 a month, which means. Less skipped refills and better adherence with the medications. And that's really what we're going for at the end of the day, to improve care and make sure the employees can access their medications and live their healthier lives. The opportunity here is to move to the cost based PBM's and it benefits everyone along the way. For employees, we just saw how it lowers the out of pocket costs and copays. Some may even get down to $0.00 depending on the pharmacy benefit and how rich you'd like to make the benefit. Additionally, the employer span plan sponsor benefits because they're paying lower net cost for drugs upfront, not having to wait for rebates and they know they're minimizing legal risks because they're pursuing the lower cost. Options. And then last but not least, the HR benefits team, there's transparency with reporting so that you can see what the drug spend is and if there are trends driving up the cost, so we can figure out solutions, which also means with the lower cost, less escalations for you all. And like Karina said earlier calls to let you know that they appreciate the benefit and they're excited to be able to have better access to the medications.

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