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Employer Strategies to Identify Effective Drug Pricing Models: Evaluate What is Working and Where Change is Warranted

World Congress

July 23, 2020
Recorded Online

The way prescriptions are priced and administered has not changed in the last two decades. Pharmacy Benefit Managers (PBMs) have constructed an opaque and complex system where they can profit off the confusion in the middle. The contract an employer signs with a PBM is often 50-100 pages long, but never includes a single drug price. Instead, employer contracts consist of complicated definitions, classifications, and exclusions that underpin average annual discounts off an ever-inflating Average Wholesale Price (AWP) benchmark.

Under the current system, each PBM has different definitions for brands, generics, specialty, multi-source and other key categories. The variability is so great, PBMs even have different definitions across their own books-of-business. As a result, prices delivered to employers remain inconsistent, hidden behind a contracting paradigm that allows for extraordinary price and guarantee manipulation.

  • Discuss the current landscape for PBM pricing and contracting from the perspective of plan sponsors, including challenges and conflicts
  • Explore successful alternative pricing models and PBM contract structures
    • Understand how specialty drugs are handled in alternative models
  • Review case study examples of plan sponsors that have transitioned from traditional PBM models to transparent/aligned models
    • Assess financial outcomes, member / patient impact, and access to data and auditability


  • Matt Gibbs, President, Commercial Markets, Capital Rx
  • Josh Golden, Senior Vice President of Strategy, Capital Rx

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