5 Things to Ask your PBM


How do you ensure we always pay the lowest net cost for drugs? Are you willing to guarantee it?

At Abarca, we always operate in your best financial interest—always. This means that, unlike most PBMs, we design and administer benefits to ensure the use of the lowest net cost brand and generic drugs, even when it makes it more difficult to achieve minimum rebate or discount guarantees. We are willing to guarantee your net cost of drugs. For us, it’s pretty simple: if we disclose everything and focus on serving our clients and members, we can be fully aligned, trust each other, and everyone will benefit in the long run.


Do you generate more margin from the traditional PBM model or the transparent one? Are you willing to prove it?

The term “transparent” is used so widely in the PBM industry that it is nearly meaningless. Here’s what we mean: Abarca discloses to our clients all revenue from all sources for all claims. No ifs, ands, buts, or maybes about it. Despite what many say, the traditional PBM model is much more profitable for the PBM and this margin comes at the client’s expense—we can live with making less money because the transparent model is better for payers and members. Is there something your PBM doesn’t want you to know?


How does your PBM technology provide me with a competitive advantage?

To be fair, this is a trick question. The industry relies on inflexible and unfriendly legacy platforms that confuse and constrain plan sponsors, and protect the PBMs’ high margins and hidden revenue. The only competitive edge most PBM platforms offer plans is in the race to the bottom. We built Darwin™, our advanced PBM platform, from scratch—to be intuitive, powerful, and fully integrated. It gives plans the ability to understand more, do more, manage their business and serve their members far more effectively.


What do you think is broken about the PBM business model, and how is your approach different?

At Abarca, we think there is a lot that is broken with the current PBM model. For starters, it’s rigged to raise drug prices, keep plans and patients in the dark, and frustrate everyone with outdated technology and a poor customer experience. Our entire company is built on three foundational principles: Delivering a smarter platform, providing a better experience and operating with a higher standard. This guides everything we do.


What are you doing to change the current “Pay for Volume” paradigm to”Pay for Value” and “Pay for Performance?

Abarca is leading the way in innovative value and outcomes-based contracting for pharmaceuticals for conditions including multiple sclerosis and cardiovascular disease. Through the RxTarget Quality Network, Abarca has leveraged the power of community pharmacies to improve member outcomes in areas such as medication adherence and compensated pharmacies based on their performance.

Is there another question you would like answered by a PBM? Ask Abarca.

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