In the world of pharmaceutical pricing, distrust and misinformation are rampant. Independent PBMs ProCare PBM and MC-21 recently combined, setting a new standard for transparency and openness in prescription drug pricing.
GAINESVILLE, GA, Aug. 5, 2019 -- The merger of MC-21 and ProCare PBM to form independent pharmacy benefit manager MC-Rx creates a new standard for transparency and openness in prescription drug pricing.
MC-Rx is a competitive and service-focused pharmacy benefit manager (PBM) option for businesses and insurers in the U.S. and Puerto Rico.
"MC-Rx clients have the ability to review and audit our contracts to ensure that the price we pay the pharmacy on their behalf is exactly the same price that is billed on their invoice," said LaMar Williams, executive vice president of MC-Rx. "Additionally, after each claim has been reconciled, we populate the same data in both the –pharmacy reimbursement field as provided in the billed amount to the client. This approach allows our clients to see that what we have reimbursed for their members' pharmacy claims exactly matches what we have billed."
Lowering healthcare costs is an important issue for most Americans, but the causes of high prescription drug prices are largely misunderstood.
PBMs absorb misplaced blame for drug costs in the court of public opinion. According to a study by the TPA network, many consumers view PBMs as a "black box," meaning "they know what they should do but they don't know if and how they do it" . Open systems and processes as deployed by MC-Rx allow clients to not only know what the PBM should be doing but easily confirm the "ifs" and the "hows".
In January, the U.S. Department of Health and Human Services (HHS) issued a proposal to ban rebates paid by drug makers to PBMs. There has been widespread concern about where the rebate money ends up. Although the rebates are supposed to be passed onto PBMs' client beneficiaries through lower premiums or out of pocket costs, they could instead be partially pocketed by the PBM themselves. Thus, even though the Trump administration abandoned this bill in early July, public skepticism about PBMs remains.
The HHS proposal further positioned PBMs at the forefront of the complex, multifaceted issue of prescription drug pricing. In reality, PBMs are the middlemen between drug manufacturers and pharmacies, helping to reduce prescription drug costs by:
- Offering home delivery for medications;
- Facilitating and creating a network of pharmacies that carry affordable and generic medications;
- Communicating with drug manufacturers to negotiate rebates that secure lower prices, and;
- Managing the high costs associated with specialty medications.
Despite these efforts by PBMs to reduce prescription drug costs, the HHS proposal included passing rebates onto consumers directly at the point of sale. After further evaluation by the Trump administration, the proposal was dropped, due in part to the statistical prediction that it could increase Medicare spending by $200 billion.
"A core tenet in our philosophy is lowest net cost, so we are in full agreement with the mandate to control drug spending, but also agree with the decision to seek avenues other than the recently announced drug rebate rule," Williams said. "The rule and timeline as proposed would have found many PBM's and their claims processing system vendors ill-prepared to accommodate the impact of the change. Public education and outreach to the industry leading to legislative reforms are vital and MC-Rx stands poised to be on the leading edge of advancement for these initiatives."
MC-Rx, a full-service pharmacy benefit manager (PBM) with corporate offices in Gainesville, Ga. and Caguas, Puerto Rico, focuses on transparency, best-in-class service and offering clients the "lowest net cost." MC-Rx was formed by combining two Utilization Review Accreditation Commission (URAC) certified world-class PBMs: ProCare Pharmacy Benefit Manager and MC-21. The newly formed ProCare company provides innovative computer software systems and services to various sectors of the healthcare industry. Together they have more than a half-century of industry experience, four major locations, two state-of-the-art 24/7 data and customer support centers, three software research and development centers, and more than 550 employees. By virtue of this combination, MC-Rx will have clients in all 50 states, Puerto Rico and the U.S. Virgin Islands. MC-Rx includes two affiliated mail-order and specialty pharmacies, ProCare PharmacyCare, and is one of only four PBM providers that own all of their component systems. For more information, visit http://www.mc-rx.com.
- Nicholas, Richard L. "Everything You Always Wanted to Know about Pharmacy Benefit Managers." https://www.aprx.org
- "Trump Administration Proposes to Lower Drug Costs by Targeting Backdoor Rebates and Encouraging Direct Discounts to Patients." Hhs.gov, 31 Jan. 2019, http://www.hhs.gov.
- Lovelace, Berkeley. "Senate Panel Wants to Bring Back Drug Proposal Loved by Big Pharma in New White House-Backed Bill." CNBC.com, 25 July 2019, http://www.cnbc.com.
- "What Is a PBM?" http://www.pcmanet.org, http://www.pcmanet.org/our-industry/.
- Sullivan, Peter. "White House Withdraws Controversial Rule to Eliminate Drug Rebates." http://www.thehill.com, 11 July 2019