There is a growing shift in the pharmacy benefit management industry toward greater transparency. A PBM, or pharmacy benefit manager, helps employers and health plans manage prescription drug benefits, including covered medications, claims, costs and pricing. Today, plan sponsors are seeking clearer information about PBM fees, rebates, drug pricing and claims data so they can better understand where their healthcare dollars are going and have greater control over their pharmacy benefit.
Fred Barstein interviewed JJ Leffler of Truscript following TPSU’s first Healthcare Fiduciaries program at Rice University. JJ discussed the frustration many plan sponsors have experienced with limited access to data, unclear pricing and a lack of visibility into how PBMs are compensated. He explained that newer, more transparent PBM models provide greater access to information and clearer fee disclosures, helping plan sponsors better oversee their PBM relationships and make informed decisions on behalf of their plans and participants.
Read the Full Transcript Here:
Fred Barstein: Greetings. This is Fred Barstein, founder and CEO of 401kTV and TPSU. We just completed our first TPSU for Healthcare Fiduciaries program here at Rice University, and I’m joined by JJ Leffler from Truscript. Welcome, JJ.
JJ Leffler: Thanks for having me. It’s a pleasure.
Fred: Before we get started, tell us a little about yourself, what you do, and what Truscript does.
JJ: Sure. I’m JJ Leffler. I’m a pharmacist, PharmD, and I’ve worked across many areas of pharmacy throughout my career.
Currently, I work for Truscript, a PBM, or pharmacy benefit manager. We help clients build and manage the pharmacy benefit they provide to their employees.
That includes managing covered medications, medication costs, claims adjudication, billing, and essentially everything that falls within the pharmacy benefit. We help plan administrators and plan sponsors manage that benefit for their employees.
Fred: PBMs seem to be in the news quite a bit right now, with changes involving regulation and legislation. What’s changing, and why is it happening now?
JJ: I think plan sponsors are frustrated. Historically, there has been a lack of transparency in the industry. Plan sponsors haven’t always been able to access their data or claims information, and they haven’t necessarily understood what was happening behind the scenes.
There’s now a transition happening in the industry toward greater transparency. Plan sponsors are gaining more access to their data, more visibility into how their PBM operates, and ultimately more control and governance.
The current push is really about transparency and pass-through arrangements—giving plan sponsors the visibility they need to make sure their PBM is operating in the best interest of the plan rather than primarily serving the PBM itself.
Fred: And like any transition, some companies are adopting this model more quickly than others.
JJ: Absolutely. There are certainly companies that haven’t adopted this approach as quickly.
At Truscript, this is absolutely how we operate. We’re trying to do everything we can in the best interest of our plan sponsors.
Fred: And there are probably financial reasons why some companies may be reluctant to make that change.
JJ: No doubt. The profit structure can be very different.
Under the newer, transparent model, fees and compensation are disclosed upfront. Our plan sponsors know exactly how Truscript is going to be paid.
That hasn’t always been the case under more traditional PBM models. There have been different revenue streams that clients may not have fully understood or even known about, which made it difficult for plan sponsors to govern the relationship or understand exactly what they were paying for.
Fred: It sounds like there’s a lot of room for improvement.
JJ: There definitely is, and that’s why it’s great that we’re here educating plan sponsors today.
Fred: Which leads to my final question. This was our first TPSU for Healthcare Fiduciaries program. What do you think plan sponsors got out of today’s program, and why should they attend one?
JJ: I spoke with many of the attendees today, and they were extremely positive about the experience.
I think they received a tremendous amount of information—maybe even more than they expected. Several said they wished they could spend a few more hours, or even a few more days, diving into these topics.
Most importantly, they gained a general education about what they should be looking for and what questions they should be asking in conversations with their brokers and pharmacy benefit managers.
A lot of what we discussed today gives them the tools to ask better questions and ultimately make better decisions moving forward.
Fred: Great. JJ, thank you for your time.
And thank you for watching. Be on the lookout for a TPSU for Healthcare Fiduciaries program coming to a university near you.
