Pharmacy Benefit Manager Solution (PBM)
The first and ONLY MBM or PBM certified to be in full compliance with the CAA
Improve efficiencies, lower costs, and improve the overall quality of care
Our PBM solution is a new class-of-trade Medical Benefit Manager (MBM), delivering a superior product with significant financial savings. They manage health care costs and improve quality of care for businesses and consumers. The innovative MBM model, coupled with a solid foundation of company stability and community commitments, has made our solution a powerful force in the healthcare industry since its formation in 2004. They were founded to create balance between profitability and affordable patient care in an industry burdened by misplaced priorities. The team applies our core values of integrity and transparency to create new healthcare delivery channels that are more consolidated and efficient. Our solution eliminates hidden margins and spreads commonly seen with traditional Pharmacy Benefit Mangers (PBMs).
Gain flexibility and control with customized solutions.
We also know one-size does not fit all. Our revolutionary healthcare model enables our clients to manage their own pharmacy benefit program by eliminating hidden costs and offering an a la carte menu of services and programs from which to choose. We listen and respond to your business, creating comprehensive and innovative solutions that are customized to work for you and those you serve.
Lawsuit Articles
Comer Announces Hearing with PBM Executives on Role in Rising Health Care Costs
WASHINGTON—As part of an ongoing investigation into Pharmacy Benefit Managers’ (PBMs) role in rising health care costs, House Committee on Oversight and Accountability Chairman James Comer (R-Ky.) today announced an upcoming hearing titled, “The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part III: Transparency and Accountability.” At the hearing, members will examine how PBMs have used their position as middlemen to cement anticompetitive policies which have increased prescription drug costs, hurt independent pharmacies, and harmed patient care. Chief executives from three large PBMs, which collectively control 80 percent of the health market—CVS Caremark, Express Scripts, and OptumRx—are set to testify on their role in rising health care costs.
Wells Fargo (WFC) Faces Lawsuit Over Employees High Drug Costs
Wells Fargo & Company WFC is facing a class action lawsuit alleging that it mismanaged its employee health insurance plan, forcing thousands of U.S.-based employees to overpay for prescription medications.
The proposed class action was filed in Minnesota federal court, claiming that the bank violated a federal law requiring firms to manage employee health and retirement programs properly. This legal action was filed by four former workers, which follows a pattern of increased scrutiny of Wells Fargo.
Per former employees, Wells Fargo’s health plan pays inflated prices to pharmacy benefit managers (PBMs), who negotiate with drugmakers, health insurance plans and pharmacies to set prescription drug prices. These drugmakers also determine which drugs will be included on their so-called formularies or lists of drugs covered by insurance.
Walgreens Reaches $360 Million Settlement with Humana Regarding Inflated Prescription Drug Prices
In January 2024, Walgreens and Humana reached a $360 million settlement to resolve ongoing lawsuits where Humana argued that Walgreens violated the PBM agreement by artificially inflating prescription drug prices for years. Humana was initially awarded $642 million by an arbitrator a few years prior, which Walgreens challenged in court.
All of this back and forth is based on a dispute over the PBM contract definition of “Usual & Customary” (U&C) pricing and Walgreens’ Prescription Savings Club (PSC). Humana argued that the PSC prices represent Walgreens’ true U&C or cash prices and that Walgreens did not submit these prices on claims to Humana. Walgreens argued that PSC prices are not U&C because club prices are not available to the general public because members must sign up and pay an annual fee to get access to these lower PSC prices.
