Drug utilization audit confirms misaligned PBM priorities

Ameripharm Pharmacy Services
January 18, 2004

AmeriPharm Pharmacy Services has completed an extensive audit of
client drug-utilization data from nationally recognized Pharmacy Benefit Managers (PBMs)
and has confirmed industry findings that misaligned priorities are driving pharmacy costs upward.


Sioux Falls, SD (PRWEB) January 18 2004--AmeriPharm Pharmacy Services has completed an extensive audit of client drug-utilization data from nationally recognized Pharmacy Benefit Managers (PBMs) and has confirmed industry findings that misaligned priorities are driving pharmacy costs upward. Payers, such as managed care organizations and employer groups, are seeking solutions to contain drug costs and eliminate conflicting priorities. Leading solutions include in-house control of pharmacy functions and best value drug utilization.

AmeriPharm’s President, Ron Bertsch, RPh stated, “The PBM generates revenue streams from misaligned formulary design, inappropriate drug switching, buy and bill practices, non-adherence to maximum allowable cost (MAC), markup of contracted services, and/or repackaging & re-pricing tactics. This is particularly evident when the PBM controls the retail network and mail order delivery system. Innovative payers are questioning the PBM practice of moving rebates to unaccounted revenue line items such as data management fees that shelter the PBM from sharing manufacturer incentives. Our audit results have confirmed many of these practices.”

Escalating litigation in 2003, against traditional PBM financial practices and their unwillingness to accept fiduciary responsibility, has prompted clients and insurers to seek alternatives in managing their prescription drug benefits. Industry experts indicate that pharmacy payers are seeking self management solutions to formulary design, rebate administration, network management and other pharmacy benefit services.

Beginning in January 2004, AmeriPharm Pharmacy Services introduced a drug acquisition cost pricing structure to promote full disclosure, transparency and fiduciary responsibility to clients and managed care organizations. Bertsch indicated that “This pharmacy business model features complete audits of drug acquisition cost, formulary administration, and pharmacy practices. Unlike traditional PBM relationships and Average Wholesale Price (AWP) based contracting, this model shifts control of pharmacy costs, quality of care, and program design to the client.”

About AmeriPharm
AmeriPharm is a national provider of mail order pharmacy and other health care related services based in Sioux Falls, South Dakota. Formed in 2003, the company’s focus is to exemplify an environment of full disclosure and transparency in pharmacy healthcare management by partnering with PBMs and payers who share the same philosophies. Find more information about AmeriPharm at http://www.ameripharminc.com./

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