1Which medicines on your formulary are driving plan costs?

This question helps uncover if the PBM is driving medication utilization toward the most cost-effective solutions or those with the highest rebates. Many medications have similar high-quality, clinically effective, nearly identical equivalents available at lower costs.

2Which medications are driving rebates?

PBMs often place drugs on a lower tier of the formulary based on the negotiated rebates from pharma manufacturers. This impacts drug utilization. Is your PBM incentivized to promote higher rebated drugs that end up costing you more?

3Are there quality, lower-cost alternatives to these rebate drivers that would be better for plan savings?

As consumers, we should be asking ourselves questions like we would in any retail setting, such as: “Would I rather get $40 back after spending $100 or would I rather pay the full price and have my total expense be $15?”