August 2024 - Recently, the FTC released an interim report shedding light on the practices of pharmacy benefit managers (PBMs). The report is a wake-up call for anyone involved in healthcare, from plan sponsors to consumers. The insights revealed are both eye-opening and concerning. Let's dive into what this means and why now, more than ever, it’s crucial to consider a fully transparent, conflict-free PBM like TrueScripts.

The Power of PBMs

Pharmacy benefit managers wield substantial control over drug formularies, which can impact drug pricing and patient access the report describes. This control means that PBMs have the power to determine which medications are available to patients and at what cost. Unfortunately, this often translates to higher prices and limited access, all behind a veil of secrecy.

“After years of acquisitions, the leading PBMs (the big six manage 94% of prescription drug claims) are each part of massive healthcare conglomerates that are often comprised of a health insurer, pharmacies, and the PBM negotiator between health insurers and pharmacies—all rolled into one. The result is that the dominant PBMs can often exercise significant control over which drugs are available, at what price, and which pharmacies patients can use to access their prescribed medications,” says the FTC.

At TrueScripts, we recognize the significant influence that PBMs have over drug formularies and the subsequent impact on drug pricing and patient access. Unlike traditional PBMs, our fully transparent and aligned approach is intended to ensure that decisions are made with the best interests of patients and clients in mind.

Our active and focused formulary management strategy is designed to achieve the lowest net cost while ensuring patients have access to the medications they need.

The Opacity of Pricing

The report also highlights how the complexity and opacity of PBM pricing mechanisms and rebate structures contribute to escalating drug costs for consumers. “PBMs oversee critical decisions about access to and affordability of medications without transparency or accountability to the public. Indeed, PBM business practices and their effects remain extraordinarily opaque,” the report describes. The traditional PBM model is inherently opaque, making it difficult for plan sponsors and consumers to understand where their money is going and why drug prices are so high.

At TrueScripts, we believe in no hidden fees and no spread pricing. Essentially every claims dollar billed to our clients is the exact cost paid to the pharmacy. Our detailed invoicing allows you to easily fact-check us, ensuring complete transparency. Additionally, TrueScripts operates on a pass-through model where rebates go directly to our clients. We are not incentivized to chase high-cost/high-rebate drugs; our goal is to keep costs low.

Consolidation and Conflicts of Interest

“The largest PBMs are now also vertically integrated with the nation’s largest health insurers and specialty and retail pharmacies,” states the FTC. “As a result of this high degree of consolidation and vertical integration, the leading PBMs now exercise significant power over Americans’ access to drugs and the prices they pay.”

The FTC calls out the misaligned incentives presented by vertically integrated PBMs, stating that they create conflicts of interest that can “disadvantage unaffiliated pharmacies and increase prescription drug costs.” When PBMs own pharmacies, conflicts of interest arise, making it impossible for them to wholly represent their clients' best interests.

TrueScripts has no pharmacy ownership of any kind, eliminating these conflicts of interest. By removing self-serving practices, we ensure patient access to care and affordability. Additionally, as a Team Member owned company (ESOP), we are not beholden to affiliated organizations or outside shareholders. Our team has a vested interest in the success and happiness of our clients.

The Need for Transparency

There is a pressing need for greater transparency in PBM operations to ensure fair practices and accountability, the report underscores. The lack of transparency in traditional PBM practices makes it challenging for plan sponsors to make informed decisions.

At TrueScripts, our straightforward, 9-page contract contains an “Affirmative Covenants and Transparency Commitments” clause that contractually obligates us to operate in a fully disclosed and mission-aligned manner. Further, we provide clearly defined revenue sources, detailed invoicing for easy fact-checking, and access to data. Our 'open book' policy provides a high level of transparency to ensure that clients stay in the loop and can trust we are managing their pharmacy benefits in the most efficient and ethical way possible.

Why Choose TrueScripts?

The FTC report serves as a stark reminder of the issues plaguing the PBM industry. It’s clear that the traditional PBM model, with its hidden fees and opaque practices, is not sustainable or beneficial for plan sponsors or consumers. TrueScripts offers a clear alternative with our commitment to transparency and patient care.

By choosing TrueScripts, you’re not just selecting a PBM; you’re choosing a partner dedicated to building a better future for healthcare.

It’s time for a change. It’s time for TrueScripts.