Ensure Real “Value” From Your Coalition

Thousands of Plans are members of Coalitions. In fact, in a recent survey of several hundred Plans, 21 percent obtained their prescription coverage from Coalitions or group purchasing organizations.

Unbeknownst to those Plans, most Coalition contracts with PBMs are plagued with the same loopholes found in virtually all other PBM contracts. As a result, almost every Plan that joins a Coalition experiences the same ever-increasing prescription coverage costs as the Plan would have experienced had the Plan never joined a Coalition.

Compounding the problem, most Plans that join Coalitions pay relatively large fees to their Coalitions. However, the Coalitions perform almost no services to merit those fees. In fact, the only service provided by most Coalitions is to conduct year-end audits, after which the Coalitions announce that their PBMs have satisfied all contract terms.

Coalitions’ pronouncements – and their failure to decrease their Coalition Members’ costs – should come as no surprise. After all, many Coalitions have entered into secret financial relationships with the PBMs that are providing services to Coalition Members.

Accordingly, every Plan that is currently a Coalition Member should obtain a Conflict of Interest Disclosure Form & Agreement from its Coalition.

Moreover, every Plan that is considering joining a Coalition should “do its homework” and determine if the Plan will actually obtain value from joining the identified Coalition.

We also urge every Plan that is currently a Coalition Member – or that is considering joining a Coalition – to review the Coalition benefits and accomplishments of our recently formed National Prescription Coverage Coalition.

Our Coalition Members’ costs have all decreased significantly given our Coalition’s airtight PBM Contract and our ongoing work. And depending on how many of our recommendations have been adopted, our Coalition Members have experienced cost decreases of between 15% and 33%.

If your Plan is a Coalition Member – or considering joining a Coalition – make sure your Plan obtains real value from its Coalition.