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October 6, 2023
I have never agreed so much with J.C. Scott from PCMA. The following is a snippet of his opening remarks from the hearing:
We are continuing our analysis of the House Oversight Committee’s hearing on the Role of Pharmacy Benefit Managers, from September 19,2023.
Mr. Scott states that “in order for the system to work” employers need access to their data to make informed decisions. He goes onto say that it is the employer’s choice as to whether or not they have access to the data. I totally agree employers and their advisors need access pharmacy claims data, at a minimum, but how many of you have been told by the PBM that the data is “proprietary?” How many of you have been notified the data release requires egregious fees to be paid, exorbitant timelines or restrictions of who and how you can use your data? I bet most of you.
Access to data is critical in effective plan management. As the American management guru, Peter Drucker said, “What gets measured, gets managed.” Without claims data and reporting, employers are not able to measure their performance. Hence, they are not able to manage pharmacy costs. It is also important to have timely access to the data. Receiving quarterly reporting packages 60 – 90 days after the end of the quarter that have data elements that aren’t meaningful and are ineffective in determining what needs to be managed. Employers need timely meaningful access to data, and that data needs to be in the hands of the partners the employers contract with to manage their benefits.
Let’s take Mr. Scott at his word and demand the PBMs provide employers timely access to their pharmacy claims data, rebate reports and other reports that support implemented programs, so that their advisors can help them better assess their pharmacy trend and determine if new strategies need to be implemented. There are a lot PBMs already providing this information to their clients as a standard service. For the most part, these PBMs are not PCMA members. Let’s continue to promote and elevate advocacy groups, such as Transparency-Rx's, that believe that employers should have access to their data.
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