GoodRx vs. Cost Containment - Tackling Rising Pharmacy Benefit Costs

Group health plans are increasingly burdened by rising prescription drug costs, largely due to ineffective Pharmacy Benefit Manager (PBM) contracts that restrict employers to formularies misaligned with their needs. While options like GoodRx may offer temporary solutions, they do not address the fundamental issues of poor PBM management and formulary design. Tackling these core problems is essential for sustainable healthcare cost control.

Discount apps can be a helpful tool for individuals, especially those uninsured or with high-deductible health plans. It provides immediate discounts on generic medications, making them more affordable. However, this reactive approach isn't suitable for group plans to manage long-term prescription trends and control overall healthcare spending. These discount solutions focuses on individual savings rather than the complex needs of self-funded employer-sponsored plans. It does not address the primary cost drivers in these plans, especially specialty drugs, the largest contributors to rising prescription costs. GoodRx operates within the existing PBM ecosystem, relying on partnerships with the big PBMs like Express Scripts and Navitus known for their opaque rebate structures and pricing practices, often inflating drug costs. Using this discount solution for group plans keep employers and plan members entangled in this system.

GoodRx has had a mixed track record. While it offers consumer discounts through partnerships with PBMs, it's faced challenges with growth and stability. Losing key partners like Kroger shows how unreliable these external contracts can be, disrupting discounts and creating uncertainty for users.

Furthermore, GoodRx's revenue has stagnated, despite increased advertising costs and declining subscriptions. They've also faced legal issues, like an FTC penalty for sharing user data without consent, and recent lawsuits alleging collusion with PBMs to suppress pharmacy reimbursements. This raises serious concerns about data privacy, competition, and the platform's long-term viability.

For employers, these legal and financial challenges highlight the risks of relying on this platform.

Instead of relying on a consumer-focused discount solution, consider switching to a smaller, independent PBM. These PBMs offer more transparent pricing, flexible contracts, and a focus on clinical outcomes. This approach avoids the hidden costs and conflicts of interest common with the bigger PBMs.?

To further manage costs, explore specialty drug management solutions:

• Prescription Assistance Programs (PAPs): PAPs connect patients with manufacturer-sponsored programs that offer significant financial assistance for specialty medications.
• International Sourcing: Consider sourcing certain specialty drugs from international markets, which may offer lower prices while ensuring quality and safety standards.
• Specialty Drug Carve-Out: Carve out specialty drug management from the PBM contract to allow for specialized strategies and targeted cost-control measures.

GoodRx can be useful for individuals, but more comprehensive solutions exist for the complex challenges of group health plan management. Relying on a discount app without addressing the underlying PBM issues will lead to unsustainable cost trends. Optimizing PBM contracts and implementing proactive specialty drug management strategies is key to controlling prescription costs. By partnering with an independent PBM and utilizing tools like PAPs, international sourcing, and specialty carve-outs, group health plans can achieve more sustainable savings while ensuring access to necessary medications for their members.

Take control of your group health plan's pharmacy benefits with a proactive, sustainable strategy. To learn more about optimizing your PBM contracts and implementing effective drug management solutions, visit https://www.apconsultgroup.com/pharmacy-benefit-insights today.