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To Re-Fill or Not: A Matter of Intent

Welcome to the world of pharmacy benefit managers (PBMs), where profit comes before patient care. You see, these PBMs have found a sneaky way to squeeze even more money out of your already hurting pockets - through auto-refill programs.


Yes, that's right folks, forget about actually monitoring your medication usage and refilling only when necessary. With auto-refill, your PBM can automatically charge for refills that may not even need. But hey, who cares about unnecessary medication and wasted money? As long as the PBMs are raking in the profits.


But wait, it gets better (or worse). Did you know that PBMs may set the refill trigger early? That means they get paid for 150% of your medication cost for an entire year, even if you only needed it for a few months. Talk about a brilliant money-making scheme! (Imagine the case of a $5000 a month biologic, the member could end up with over $30,000 in wasted medicine per employee.)


And the best part? PBMs can use this feature indiscriminately, leading to over-utilization and more wasted money. But hey, they're not the ones footing the bill, so why should they care, right?

But don't worry, employers and health plans alike can fight back. Just ask your PBM for a report on members who received more than 365 days of therapy in the past year. If there's significant over-utilization, that's a surefire sign that the auto-refill feature is benefiting the PBM at your expense.


So let's all give a round of applause to PBMs for finding yet another way to prioritize profits over the well-being of patients. The INTENT of your PBM matters. Spreadsheets do as well, but not as much as folks think as illustrated earlier, a PBM can recoup pricing deficits in a relatively swift period of time.


But don't lose hope, because change is possible. Veritas Rx, is more than an adjudicator of claims, it is a movement, a movement toward transparency in an industry that sorely lacks it. Fair pricing and access to all, helping get the right script to the right person at the right time at the right price. Join us today!

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