As transparent pricing continues to be a key topic for workers’ compensation PBMs, Mike Cirillo, President of myMatrixx, recently sat down with Risk & Insurance magazine to discuss common myths that are out there in the marketplace. According to Cirillo, these myths can include an overemphasis on rebates, the notion that pass-through pricing always saves money, and that a PBM should charge a flat fee to cover administrative services. Throughout the article, he explains how PBMs that take advantage of these myths often do it by cutting out essential services.
Ultimately, Cirillo stresses that there is no substitute for a PBM that can provide clinical oversight, strong pharmacy network relationships, deep data analytics and personalized customer service. PBMs that are unable to do these things can very often end up compromising a client’s long-term claims management strategy and negatively affecting outcomes for injured workers. Additionally, many PBMs that tout transparent pricing schemes don’t have direct contracts with pharmacies, which often translates to higher prices for medications.