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Most Rx plans require pass-through PBM pricing


A survey by the International Foundation of Employee Benefit Plans has found that 69% of benefit plan sponsors using a pharmacy benefit manager require their PBMs to pass through all manufacturer rebates, discounts, fees and other payments.

The survey, included in the new book "Pharmacy Benefit Managers" published by the Brookfield, Wis.-based foundation, also found that 63% of plan sponsors that use PBMs include financial and performance guarantees in their PBM contracts. The same percentage also require an unrestricted right to audit their PBMs.

The survey found that mail-order drug service was the most popular cost-containment technique used by plan sponsors, with 87% offering the services to plan participants. Other cost-containment techniques identified by respondents were drug formularies, used by 79%; mandating or promoting generic drug use, used by 79%; and a system of three or more tiers of cost-sharing devices such as deductibles, coinsurance and copayments, used by 76%.

Of respondents using PBMs or other vendors, 89% said they are satisfied or very satisfied with their current service provider, while 12% are in the process of choosing a new provider, and 14% plan to change vendors within the next 12 months.

The survey includes information from 163 U.S. respondents. Of those, 53% were from corporations, 31% were from multiemployer trust funds and 15% were from public employers.

"Pharmacy Benefit Managers" is the latest installment in the foundation's "Sample Series," which was created to provide survey data and samples on a variety of employee benefits topics to allow benefit professionals to compare their plans to others, determine trends and costs, and better manage their plans. The book also includes seven sample request for proposals and one sample vendor selection tool.

To purchase a copy of "Pharmacy Benefit Managers," visit; contact the foundation's publications department at 888-334-3327, option 4; fax 262-786-8780; or e-mail The 336-page publication is available in CD-ROM, e-book or print format. The cost is $45 for members, $112 for nonmembers, plus shipping and handling.