As employers evaluate their plans and prepare for 2027 renewals, now is the time to take a closer look at the decisions shaping next year’s pharmacy benefit strategy. Rising pharmacy costs, evolving treatment options, and increasingly complex market dynamics can make it difficult to determine whether your current approach is delivering the value you expect without compromising care.
Before renewal decisions are finalized, make sure you’re asking your pharmacy benefits consultant the right questions. The answers can help uncover opportunities, validate your strategy, and ensure you’re prepared for what’s ahead.
6 Questions to Ask Your Pharmacy Benefits Consultant
1.) Are the rebates we receive lowering our costs or masking higher drug prices?
- Often, it can make more financial sense to fill lower cost/lower rebated drugs to decrease overall net drug spend.
2.) Are our employees getting the lowest-cost clinically appropriate drugs, or the preferred formulary drugs?
- There may be lower cost drugs that the PBM doesn’t have on the formulary; this is a great time to determine if that is happening and course correct.
3.) What is the drug pricing methodology in our contract, and what are our audit rights?
- It’s important to know if your PBM is earning spread on your drug claims, and also if you have the right to bring in an independent auditor to review your claims and rebates.
4.) What is driving our pharmacy spend today?
- Understanding your top drugs and drug classes by both cost and utilization can help you make decisions on clinical programs or outside vendors to help control spend.
5.) What emerging trends or high-cost therapies should we be preparing for in 2027?
- Using the claims data from this year can show you which disease states are prevalent for your employee population. Your consultant can advise on new emerging therapies for those diseases.
6.) Are there opportunities to improve value without compromising care?
- Making plan changes doesn’t always have to mean negative changes for your employees. There may be options available to not only improve value but also enhance the care your employees receive.
Key Takeaways
Asking the right questions is the first step toward taking greater control of your pharmacy benefits. If you’re planning for 2027 and want to see costs more clearly, understand usage, and negotiate better terms, connect with Ethica Pharmacy Advisors. As an independent partner, we’re loyal to your best interests and committed to helping you make informed decisions with confidence.
