Not Every PBM Is Created Equal

Amidst the ongoing legislative and regulatory scrutiny of the largest pharmacy benefits managers (PBM), it’s crucial for plan sponsors and the public to understand that there are alternative PBMs who play an important and meaningful role in the health care industry. Our business is personal. For us at Navitus, as a fully transparent PBM, we operate every day in alignment with our mission to ensure individuals and families have access to affordable prescription drug coverage and the medications they need. 

We don’t take spread, and we never will. Like any PBM, Navitus works with manufacturers and pharmacies to secure the best pricing, rebates and discounts possible on behalf of our clients. But, traditional PBMs may take spread (also known as a margin or mark-up) and charge the plan sponsor more than the pharmacy was paid, adding cost to the system. These can include retail spread, mail-order spread, specialty pharmacy spread, maximum allowable cost (MAC) list spread, and hidden non-disclosed fees. Instead, our clients pay what we pay. We pass 100 percent of all discounts or rebates received directly through, allowing us to pass on savings and remove — not shift — unnecessary costs in the drug supply chain.  

An alternate model exists, where plan sponsors have full visibly into PBM performance and results and pharmacy and manufacturer contract fees and charges. This enables plan sponsors to make fully informed decisions to fine-tune their pharmacy benefits. As a result, they are positioned to provide more affordable benefits that allow health care consumers to access essential medications.