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Examining the case for direct contracting: A multistakeholder case study
Journal of the American Pharmacists Association : Japha
|July 13, 2023
Summary
Direct contracts for prescription drug payments can save employers and employees money. This study found that direct contracting offers financial benefits and more transparent pricing for employers and pharmacies.
Area of Science:
- Health economics
- Pharmacy management
- Healthcare policy
Background:
- Prescription payment systems present challenges for employers and pharmacies.
- Direct contracting models for prescriptions and bundled services show potential benefits.
Purpose of the Study:
- Explore direct contracting through multistakeholder interviews.
- Compare employer/employee prescription costs under PBM vs. direct contract.
- Project pharmacy financial outcomes under a direct contract.
- Assess employee satisfaction with direct contracting.
Main Methods:
- Semistructured interviews with stakeholders.
- Analysis of employer PBM invoices for 412 prescriptions over 6 months.
- Financial projections for direct contract scenarios.
- Descriptive analysis of employee satisfaction survey data.
Main Results:
- Stakeholder interviews highlighted benefits and challenges of direct contracts.
- Financial analysis indicated potential savings of $5,664 for employers and $1,918 for employees.
- Projected pharmacy profit under the direct contract was $899.
- Employees reported general satisfaction, with limited use of bundled services.
Conclusions:
- Direct contracting can be financially advantageous for employers, pharmacies, and employees.
- This model may provide greater pricing transparency.
- Increased utilization of bundled services could enhance employer value.
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