The Choice Is Yours

Do you remember the song, "The Choice is Yours" by Black Sheep? Boomers, Gen Z, Millennials - You heard it in a movie or commercial ... #facts ... I asked a few in the office this morning - Blank stares until I started saying (er, rapping) the lyrics ("You can get with this or you can get with that - The choice is yours"). Rylie Gray , Rogan Schoenborn , Luke Watson - Thank you for your attention this morning. The rest of us (Gen Exers!) back in '91 either had the cassette tape or recorded the song off the radio onto cassette tape. The group has been in the news quite often lately.

Black Sheep's original contract from the late-80's had an "unforeseen clause" within the terms & conditions.?Meaning, if in the future there is an unforeseen format to sell their music beyond vinyl, cassette, or CD, they earn 50% of sales.?So, by definition, they should have received 50% of each, every download/stream since the inception of streaming services (circa 2008).?They haven't and the group is spearheading a class action lawsuit against Universal Music Group (UMG) for $750MM.??

Besides being a sucker for stories pertaining to music from middle school, why has this been on my mind so often? Well, I've learned over the years that language in contracts matter.?

In my line of work (#EmployeeBenefits), everything ties back to the agreement.?#DisabilityInsurance.?#LifeInsurance.?#DentalInsurance.?All of it. More than anywhere else, I see this in #PharmacyBenefits.

I've been on a mission to help employers buck #StatusQuo.?Status quo in pharmacy benefits is costing employers.?Period.?Why? Because far too often I (still) see #employers disadvantaged by traditional #PBM agreements that lack transparency and come with unnecessary cost.?See this article I wrote a few years back.?

Believe me, if you're an employer who has one of these traditional agreements, once the issues are uncovered, you might feel like suing your pharmacy benefits manager.?You won't be able to - Why? Because of the language in the contract you signed.?But what you can do moving forward is get the contract language aligned with best practices.?Net result could lead to happier employees and lower cost.?I've seen everything from minor tweaks that save the employer 10-15% of their pharmacy benefits spend to over 50% of their spend.?

For example, with traditional, spread-based contracting, you're giving the Pharmacy Benefit Manager (PBM) the ability to charge you, the employer, one amount per script, and reimburse the pharmacy a different (higher!) amount.?This plays out thousands of times a year in traditional PBM agreements.?Important to note, stripping out the fat in these spread-based contracts doesn't come with disruption to your plan members or how you administer the benefit.

There are dozens of opportunities to take corrective action - Lesser of Logic, Audit Provisions, network design to name a few.?Solving these issues for employers has been a personal mission of mine.?If you're unsure where you stand with these issues or unsure if you have the right representation to course correct, don't hesitate to reach out to me (slong.apexbg.com).?The solution is within reach.?Will you take action? Remember, #TheChoiceIsYours