Pharmacy Benefits: Closing the Affordability Gap

We’ve seen prices increasing in a variety of sectors, but there are few areas that affect people as much as medical. A large part of this is the rise of the affordability gap, a disconnect between the cost of care and a member’s ability to pay. Between rising drug prices, inflationary pressures and benefit complexities, this gap is widening at a rapid pace, making it more difficult for patients to access the medical solutions they need. And it shows no signs of slowing.

One factor of the affordability gap is high out-of-pocket costs. Between steep deductibles and coinsurance costs, a financial barrier is formed that rebuilds itself every year. Add to that the trend of plan sponsors shifting more costs to members due to the inflationary drug prices. But it’s the vulnerable populations that are hit hardest. Those who, due to financial insecurity or expensive medical conditions, are facing disproportionate challenges in affording care.

It leaves millions of people wondering if anything can even be done.

Understanding the Value of Transparency

The key solutions to these issues for plan sponsors lie in transparent pricing models and enhanced digital tools.

As the first and only open-book pharmacy benefit manager (PBM), Navitus strives to shrink the affordability gap through our business model:

• One fully transparent revenue model – A single disclosed administrative fee with no hidden margins, spreads, markups or retained rebates
• 100% of rebates and discounts passed through – We deliver the full value of negotiated savings and never stop at minimum guarantees
• Full access to data and insights – Clear reporting and actionable analytics that help you understand drivers of spend and optimize performance

Navitus also offers a range of digital tools to enhance member engagement and create personalized savings opportunities.

Smaller Gap, Bigger Benefits

Shrinking the affordability gap is about more than just doing what’s right for payers. Being able to afford medical care has a long-term impact. Medications being within financial reach leads to better adherence, improved outcomes and a reduced total cost of care. For plan sponsors, this means healthier populations and more predictable budgets. And that’s a win-win.

Ready to tackle the affordability gap and change the way your PBM works for you? Reach out to us at [email protected].