Understanding Pharmacy Benefit Consortiums

Understanding Pharmacy Benefit Consortiums
January 12, 2023 Sue Riordan
Understanding pharmacy benefit consortiums

Pharmacy benefit consortiums, also known as coalitions, collectives, or collaboratives, offer self-insured plan sponsors an opportunity to gather competitive bids from leading pharmacy benefits partners. The primary goal of a pharmacy benefit partner? Often called pharmacy benefit managers (PBMs), it’s to construct prescription drug benefit offerings in a way that reduces wasteful spending.

However, like any partnership, there can be pros and cons. We’ll take a look at some of these below to help in better understanding pharmacy benefit consortiums, as well as other alternatives.

Role of a consortium

Consortiums consolidate coverage for multiple employers or plan sponsors and actively shop for PBMs that offer attractive opportunities to save money. In other words, when small or mid-sized employer groups come together under this type of arrangement, they can purchase or pool benefits and experience clinical programming as a larger group would.

What are the pros of this setup?

Some advantages may include:  

    • Better overall pricing.
    • Assistance, recommendations and data support for considering plan changes.
    • Chances to explore solutions and programs that would otherwise only be available to larger employer groups.
 What are the cons?

However, consortiums can come with negatives, too. A few of these include:

    • Risk of losing personalized, more targeted account management.
    • Potential for reduced control in customizing benefits solutions, plan preferences and limiting risks.
    • Lack of proactive coordination between medical and care management programs.
    • Frequent disruption to member services, without an intermediary involved.
    • Likelihood for pharmacy and medical renewal periods to be out of alignment.

While participating in a consortium may be the right fit for some, weighing pros and cons is very important to understanding if it’s right for you. As an alternative, finding a partner with built-in versatility can be a better choice. Even more beneficial is connecting to a partner who will work closely with you to thoughtfully combine your medical and pharmacy benefits into your plan design.

Choosing a versatile partner

Meritain Health Pharmacy Solutions (MPS) is creating pharmacy benefit plans designs many plan sponsors thought were out of reach.

Here’s some of what MPS can offer:

    • Industry-leading PBM pricing and contracts
    • Programs for high-cost drug spending
    • Integrated medical and pharmacy benefits
    • Personalized support
    • CARE Program for reducing member and plan sponsor costs
    • Cost management for groups of every size and demographic
    • Ability to thoughtfully bundle pharmacy with medical plan administration
    • Focus on well-rounded total cost of care
    • And more!

Contact Meritain Health® to learn more about our market-leading pharmacy benefits.

This article is for informational purposes only, and is not meant as medical advice.