Corporation Benefits
For years, traditional Pharmaceutical Benefits Managers (PBMs) have faced negative press over their services and their role in inflating drug costs. A new transparency model has emerged in which the PBM discloses drug costs, thereby making the transaction more transparent. Pharmaceutical Benefit Administrators and consultants are now bringing a new model to manage PBMs and ensure they deliver benefits to the plan.
Centric believes a new model is on the horizon, and Centric is bringing it to the market.
Key Strategies for Saving Costs
- Choose a Transparent PBM
- Leverage Data Analytics
- Customize Plan Design
- Formulary Management
- Utilization Management
- Cost-Sharing Strategies
- Retain Unspent Funds
- Avoid State Premium Taxes
- Mitigate Risk with Stop-Loss Insurance
- Promote Preventive Care and Evaluation
Emerging 2026 Alternatives
- Modernizing Pharmacy Benefit Models
- Transparent PBMs
- Care-Out Strategies
- Unbundled and Cost-Plus Models
- Aggressive Clinical & Utilization
- Biosimilar and Generic Prioritization
- Target Prior Authorizations
- Site-of-Care Redirection
- Alternative Sourcing Discounts
- Direct-to-Consume (DTC) Discounts
- Rx Optimization Programs
- Plan Design and Cost-Shifting
- Higher Cost Sharing
- Variable Copay Structures
- Wellness and Preventive Care
- Oversight and Data Analytics
- Contract Audits
- Predictive Analytics
Rx Optimization Programs
- Identify Clinical and Therapeutic Waste
- Identify “Me-Too” Drugs
- High-Cost Combination Drugs
- OTC Equivalents
- Sourcing and Pricing Optimization
- Real-Time Sourcing
- Historical Overcharge Detection
- Utilization and Adherence Tracking
- Polypharmacy Management
- Predictive Non-Adherence
- Duplicate Prescriptions
- Inventory and Dispensing Oversight
- Expiry Alerts
Discarded Amount Tracking
Centric believes the next alternative is for larger corporations to manage their own drug benefits, removing the middleman altogether. Most of the alternatives above focus on drug costs or on reducing them. A company that manages its own program can save money on claim fees, prior authorization fees, rebate management fees, and other operational costs.
Centric recognizes that this transition is not simple, which is why it is bringing together solution partners to make it easier.
Risks of Operating Without a PBM
- Loss of Negotiating Power
- Administrative Burden
- Higher Direct Costs
- Compliance & Regulatory Complexity
Primary Benefits of Bypassing Traditional PBMs
- Elimination of hidden fees
- Total Rebate Retention
- Direct Control Over Formularies
- Real-Time Data Transparency
- Predictable Cost Structures
- Improved Employee Experience
Transformation Support
- Flexible and User-Friendly Adjudication Engine
- Partner assists in negotiating low-cost drug contracts
- Predictive analytics that focus on conditions and how to save money at that condition level
- Building formularies that effectively match the needs of the employees
- Direct control of member experience
- AI-driven solutions to predict opioid addiction
- AI-driven medical record scanning and summarizing
- Real-time data monitoring through the platform
