PBIRx Growth Fueled by Johnson & Johnson ERISA Lawsuit

A message from PBIRx Founder & President

MILFORD, Conn.--(BUSINESS WIRE)--A message from PBIRx Founder & President, Patricia Sirowich: PBIRx is a consulting and auditing firm totally focused on the pharmacy benefit for over thirty years. Concerns of pharmacy benefit mismanagement resulting in higher premiums, copays, coinsurance, drug costs, deductibles, and lower wages or limited wage growth caused one employee to allege a fiduciary breach in a 75-page lawsuit against Johnson & Johnson.

Self-funded ERISA plan sponsors and their benefit advisors are engaging PBIRx for our guidance to prevent their clients from being in a similar situation. There is a major focus on the exorbitant generic costs and especially Specialty generic drugs. Plan sponsors must demonstrate that there has been due diligence in evaluating, selecting, and monitoring of their PBM partner to ensure they are meeting their fiduciary responsibilities. The facts shared in this lawsuit have attracted multiple concerned mid to large size self funded Plan Sponsors to PBIRx and our all-inclusive pharmacy benefit consulting and auditing services.

PBIRx is one of the first “independent” pharmacy benefit consulting firms that not only prefers PBMs that offer transparency, but also allow PBIRx to audit our clients’ PBM pricing, rebates, clinical programs, and service level performance measured to contractual guarantees. We are the only consulting firm that requests a PBM contract with the Proposed financial model stated in the RFP with calculation methodology for each financial guarantee along with a repricing file. As an example, the generic price guarantee can be different from what is stated in the proposal, different than the repricing file, and different than the contract language, which forces the PBM to recognize that PBIRx is an experienced, knowledgeable, and detailed consulting firm. PBIRx is not a PBM, coalition, or optimizer, and fully discloses all fees.

Every client has different needs and cultures. PBIRx listens to and confirms with every client to be sure that there is a clear understanding of their pharmacy benefit strategies. It is well known that the top three PBMs are owned by or own an insurance company and as public companies are beholden to their stockholders and not necessarily the client. Yet even with that, some larger companies tend to want to work with the top three even though they know they will be paying more than they would with a mid-size transparent PBM.

Another example is that 90% of the time traditional and specialty generic drugs are lower in cost through the retail pharmacy if your PBM agreement has been negotiated with competitive guarantees. Specialty generics can be outrageously higher through a specialty pharmacy unless your consultant understands, negotiates, and audits specific guarantees. One word missing in the contract can cost a Plan Sponsor, depending on the size of the plan, hundreds of thousands of dollars or more.

Plan Sponsors should routinely have their pharmacy benefit contract and claims audited by an experienced pharmacy benefit auditor like PBIRx to ensure that contractual guarantees have been met and identify areas of improvement.

About PBIRx
Our mission is to create optimal healthcare outcomes while minimizing overall healthcare costs. PBIRx is not a PBM. Since its founding as the first pharmacy benefit consulting and auditing firm in 1993, PBIRx has saved clients over $381 million, combating excessive profits of PBMs and pharmaceutical manufacturers. As a client advocate and educator, PBIRx’s primary goal is to manage pharmacy benefit costs for clients with a major sensitivity to their diverse cultures and needs. Our deep knowledge and advanced tools have helped us build lasting relationships and empower our clients to unravel the complexities of the ever-evolving pharmacy benefit industry. We are proud to be recognized as an Inc. 5000 fastest-growing company, a SOC 2 Type 2 certified company, and a certified Woman Owned Small Minority Business Enterprise.

To learn more, please visit PBIRx.com and follow @pbirx on X or PBIRx on LinkedIn.