Supporting Health Plan Fiduciaries To Face Increased Rebate Management Scrutiny

Hidden pharmacy benefit fees and opaque rebate structures are creating serious governance challenges for health plan fiduciaries. Financial stewardship has become a high priority for fiduciaries of employer-sponsored and government health plans that must show clear, responsible oversight of plan assets – or face legal charges.

“RxLogic recognizes these issues and is helping fiduciaries to reimagine rebate management -- not as a technical or administrative function -- but as a core governance responsibility,” says Lori Daugherty, CEO, RxLogic. “Our technology platform and solutions result in smarter, transparent rebate management that offers more than financial benefits. We are aligned with fiduciaries to provide a foundation for audit-readiness, regulatory alignment and trust with plan participants.”

In a peer-reviewed article published recently in Employee Benefit Plan Review, Daugherty describes the failure of legacy PBM models to uphold financial integrity and recommends components of a rebate platform to protect fiduciaries:

Pass-Through Rebate Data: Includes any data, including submissions, receipts, rejections, payments, et. al.

Multi-Vendor Integration: Opportunities to leverage partnerships with leading rebate vendors while remaining vendor-agnostic and aligning each plan with the solution that best fits its needs.

Comprehensive Audit-Ready Reporting: Verifies that the claims adjudicate accurately, according to the plan’s summary plan description and contractual agreements.

Flexible Financial Models: Smart financial solutions designed to evolve with health plan needs and align with their financial strategy and risk tolerance.

“RxLogic is reframing rebate management with new tools and standards to advance transparency, deliver real-time adjudication and pricing and allow plan sponsors to align with multiple partners and avoid being locked into restrictive or proprietary networks,” wrote Daugherty. Our dynamic market pricing and value-based purchasing approach support vendor-agnostic rebate models, prioritizing best available price, not just the best rebate.”

RxLogic audit-grade data transparency and smart tools support fiduciary responsibilities to lower net drug spend, optimize formulary and drug utilization trends and strategically manage the specialty drug spend.

“We are restoring confidence in plan management and rebuilding trust through transparent practices,” she stated.