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ScriptSourcing: The PBM-Agnostic Solution for Consistent Pharmacy Benefits Management

ScriptSourcing’s PBM-agnostic approach offers a unique and valuable proposition in the ever-changing landscape of pharmacy benefit management. This strategy provides consistency and continuity for employers, even as they navigate the frequent transitions between Pharmacy Benefit Managers (PBMs).

Recent studies have shown that employers, on average, switch PBMs every one to three years. This frequent turnover is often driven by the search for better pricing, improved services, or more favorable contract terms. However, these transitions can be disruptive and costly, potentially impacting employee care and employer budgets.

ScriptSourcing’s PBM-agnostic model is designed to transcend these frequent changes. By remaining independent of any specific PBM, ScriptSourcing can maintain its relationship with employers regardless of which PBM they choose to work with. This consistency allows for long-term strategic planning and continuous cost optimization, unaffected by PBM transitions.

The company’s approach focuses on sourcing medications at significant discounts, typically achieving savings of 25-75% on specialty and brand-name drugs. This service complements rather than replaces the PBM’s role, allowing ScriptSourcing to work alongside any PBM an employer selects.

ScriptSourcing’s model aligns perfectly with employers’ interests. The company typically operates on a performance-based compensation structure, earning revenue only when it generates savings for its clients. This arrangement ensures that ScriptSourcing remains motivated to deliver value regardless of the PBM in place.

Moreover, ScriptSourcing’s PBM-agnostic stance allows it to provide unbiased advice and solutions. It can objectively assess the offerings of different PBMs and help employers navigate the complex pharmacy benefit landscape without any conflicts of interest.

By maintaining a consistent presence through PBM changes, ScriptSourcing offers employers a stable partner in managing prescription drug costs. This continuity not only simplifies the transition process between PBMs but also ensures that cost-saving initiatives and employee wellness programs remain uninterrupted.

In an industry where change is constant, ScriptSourcing’s PBM-agnostic approach provides a reliable anchor for employers seeking to optimize their pharmacy benefits while maintaining flexibility in their PBM choices.

New Class-Action Lawsuits Target Group Health Plan Tobacco Surcharges

A new wave of class-action lawsuits is targeting employers that apply health insurance premium surcharges to employees who use tobacco, accusing them of discrimination and violating the Employee Retirement Income Security Act (ERISA), according to two new blogs by prominent law firms.

The lawsuits, according to a blog by Chicago-based Thompson Coburn LLP, assert that the surcharges are violations of fiduciary duty rules under ERISA, as well as discrimination regulations under the Health Insurance Portability and Accountability Act (HIPAA).

The law firm says these cases are being filed across the country on an almost daily basis and to date no courts have ruled to have the cases dismissed.

The fast-developing lawsuit trend is notable, considering that tobacco surcharges are widely used, and if any of the new lawsuits are successful, they could set a precedent that could expose thousands of employers to legal action. Most of the lawsuits are against self-insured plans, but even employers who purchase health insurance and also impose surcharges for tobacco use could be targeted as they are considered “fiduciaries” under ERISA.

The lawsuits hinge, in part, on a HIPAA prohibition on group health plans and wellness plans discriminating on the basis of health status. For example, health plans are barred by the law from charging higher premiums to group health plan participants with pre-existing conditions.

However, HIPAA has one exception to the rule: It allows plans to charge different premiums for employees who enroll in and adhere to “programs of health promotion and disease prevention.”

You can find HIPAA’s non-discrimination rules for wellness plans here.

The lawsuits target a common practice: requiring employees who use tobacco to pay higher health plan premiums than their colleagues who certify that they don’t use tobacco products (cigarettes, e-cigarettes, chewing tobacco and similar products).

Common themes

The lawsuits have two common themes. They allege that the plan:

Did not provide an alternative standard for tobacco users to obtain a discount because the premium reductions for participating in the wellness plans are only available on a prospective basis, in violation of ERISA Section 702, and
Failed to provide information on the existence of such alternatives in “all plan materials.”

The lawsuits typically seek several of the following remedies:

Declaratory and injunctive relief.
An order instructing the employers to reimburse all persons who paid the surcharges, with interest.
Disgorgement of any benefits of profits the businesses received as a result of the surcharges.
Restitution of all surcharge amounts charged.

It should be noted that as of the end of October 2024, no court has ruled on a motion to dismiss a case, according to the blog. At least one case has settled as a class action and the employer and plaintiffs in another class-action case had informed the court that they were working on a settlement agreement and would both ask the court to dismiss the case.

In addition to these private actions, the Department of Labor has sued several employers targeting premium surcharges, including in 2023 when it brought action against a firm whose health plan was charging tobacco users a $20 per month surcharge, according to a blog by Washington, D.C.-based Groom Law Group.

The takeaway

Thompson Coburn said in its blog that these types of cases are snowballing: “Given the number of complaints being filed weekly — at times daily — it is highly possible that any group health plan that applies tobacco surcharges as discussed faces the possibility of a class action lawsuit.”

The law firm recommends that businesses consider reviewing their health plans to ensure that they comply with HIPAA’s non-discrimination rules for wellness plans, which allow tobacco surcharges when applied properly, such as charging different premiums for workers who enroll in and adhere to a program that’s focused on promoting health and preventing disease.

This is a newly evolving threat to employers. We’ll provide future updates after courts rule on the merits of the cases, which will provide more guidance on when tobacco surcharges can be applied.

Aligning Interests: How ScriptSourcing Transforms PBM Relationships for Business Savings

The misalignment of interests between a Pharmacy Benefit Manager (PBM) and a business can have significant and far-reaching consequences. When a PBM’s primary focus is on maximizing its own profits rather than optimizing costs for its clients, businesses often find themselves grappling with inflated prescription drug expenses and reduced healthcare efficiency.

One of the most direct impacts is the unnecessary increase in healthcare costs. PBMs with misaligned interests may engage in practices such as spread pricing, where they charge employers more for medications than they pay pharmacies, pocketing the difference. They might also push for the use of higher-cost drugs when equally effective, less expensive alternatives are available. These practices can lead to a substantial financial burden on businesses, affecting their bottom line and potentially forcing them to make difficult decisions about employee benefits or other operational expenses.

Furthermore, the lack of transparency in traditional PBM models can make it challenging for businesses to understand and control their prescription drug spending. This opacity can hinder effective budget planning and limit a company’s ability to make informed decisions about their healthcare strategy.

The ripple effects of these increased costs can extend beyond just financial considerations. Employees may face higher out-of-pocket expenses for their medications, potentially leading to decreased medication adherence. This, in turn, can result in poorer health outcomes, increased absenteeism, and reduced productivity – all of which directly impact a business’s performance and profitability.

ScriptSourcing stands out in the healthcare cost management landscape by offering innovative solutions that complement, rather than replace, existing PBM relationships. We are not a Pharmacy Benefit Manager (PBM), but rather a specialized service provider focused on alternative medication sourcing options. This unique position allows us to partner with nearly all PBMs, ensuring flexibility and continuity for our clients.

Our expertise in the PBM space enables us to provide valuable insights and analytics to brokers, helping them determine the most suitable PBM for their clients’ needs. We understand that employers often change PBMs every few years, which can lead to disruptions in service and care. To address this, ScriptSourcing has developed an agnostic approach to alternative sourcing services. This strategy ensures that employers receive the best solutions, engagement, and technology, regardless of their chosen PBM.

By offering our services independently of PBM changes, we help employers avoid the disruption typically associated with switching providers. Our model is designed to work seamlessly alongside various PBMs, providing consistent cost savings and improved medication access for employees. This approach not only benefits self-funded employers of all sizes but also creates a stable environment for long-term healthcare cost management and employee satisfaction.

Open Enrollment Prep: Identify Workers’ Needs, Consider Costs to Plan Benefits

It’s almost time for year-end small group open enrollment and you need to drive engagement so that your employees can make informed decisions about their health insurance options.

We want to help you help your employees understand all of their options so that they can purchase a plan that is appropriate for their situation. So here is our advice for the open enrollment:

Listen to your workforce

Before you make any decisions, you should listen to your employees and better understand their needs and preferences.

With answers and feedback in hand you can create a benefits package which is more appealing to them, which in turn gives you a competitive edge when attracting and retaining workers.

Engage employees and solicit feedback through quarterly employee-benefits round table meetings. Invite employees from different age groups and different departments to participate in these meetings to ensure you have a good cross-section of your staff represented.

Give advance notice

You can start this month with simple reminders for them to start thinking about open enrollment and evaluate their current health plans. Send out memos and place posters in high traffic areas.

If you start with this in September or October, they can have time to assess their options, particularly if anything has changed in their lives like marital status, new children or health issues.

Costs are paramount

You can work with us to settle on plan arrangements that will be within your and your employees’ budgets (in their case, the plans also have to be deemed affordable under the Affordable Care Act).

Employees have a right to understand the costs, so let them know how to access the free transparency tools provided online by most medical carriers. Provide employees with a breakdown of medical and pharmaceutical cost increases to avoid sticker shock.

Get an early start

If your plan year starts Jan. 1, you should hold open enrollment meetings and dispense plan materials in October or November.

Avoid holding meetings in December. It’s too busy and the ramping up period is too short.

Communicate effectively

Your task is to get employees out of cruise control and truly assess all of their options.

This is especially true if you are making changes to cost-sharing, introducing new plans, introducing a wellness plan or health savings accounts or flexible spending accounts.

You should use a variety of different media to communicate with your workforce.

Use video, virtual and live meetings, e-mail communications and print materials to get through to your employees. While the attentive ones may think it’s overkill, using different forms of communication ensures that you reach the widest number of staff.

Get spouses involved

If you also offer insurance to spouses, you should communicate through your employees that they are also invited to join your open enrollment meetings.

You can also invite them to view any electronic material you may post online, like the aforementioned videos.

If they cannot make a general meeting, you can invite them to come in to meet with your human resources manager if they have questions.

Remind them of the Law

You can use open enrollment as a way to remind your staff of their responsibilities to secure coverage under the Affordable Care Act.

Let them know that employees who refuse affordable coverage from their employer and opt to purchase it on a public exchange will usually not be eligible for government premium subsidies.

Ask us about the most frequently asked questions about the ACA and we can help you prepare a list of online resources that they can access to get answers to those questions you may not be able to answer.

The meeting

Send out meeting notices early to give your employees time to prepare and set aside time.

Try to make the meeting engaging.

You may want to consider video recording the session and also providing remote access to employees who don’t work onsite.

Provide enough time for the main presentation as well as questions from your employees.

Study: More Than Half of Workers Regret Open Enrollment Decisions

More than half of employees regret the coverage decisions they make during open enrollment, according to a new study.

Part of the problem may be that the average employee spends only 30 to 60 minutes selecting their benefits during open enrollment, which typically lasts about two weeks in most workplaces, according to the study by financial service firm Equitable. For perspective, the average American spends 120 minutes a day on social media.

The findings in the study underscore the importance for continuing education and outreach on their benefits and providing your workers the opportunity to ask questions in a private setting.

The top reasons employees cited for regretting their decisions include:

25% said they failed to adjust their benefits to match their lifestyle changes.
20% forgot to make changes to their benefit selections by the deadline.
19% did not understand the options available or the benefits they selected.

It should be noted too that sometimes the regret comes after the plan year starts and an employee in a high-deductible plan, low- or no-premium plan has a health issue that crops up or an accident, and has to pay thousands out of pocket. At that point they may rue their choice, even though they would have paid more in premiums.

One of the more disturbing findings from the study is that nearly 25% of workers said they go to social media to educate themselves about employee benefits. The numbers were highest among Gen Z workers (43%) and millennials (37%).

On the other side of the spectrum, 67% of baby boomer employees and 60% of Gen X workers were more likely than younger generations to rely on information provided to them by their employer and benefits broker when making health plan and other coverage decisions during open enrollment.

How you can help

Employers can help their employees make smart health plan decisions by:

Not inundating them with lengthy educational materials. Often clear and concise materials are best, especially ones that use bullet points and infographics. Benefits experts recommend providing employees bite-sized information that can help them whittle down their choice.

The materials should give different scenarios for workers to help them decide on a plan, such as:

A 27-year-old single female employee with no health problems, spouse or dependents.
A 46-year-old married father of three young kids.
A 58-year-old divorced woman with high blood pressure and asthma.

Keeping the open enrollment period short. Many brokers will tell you that the longer the open enrollment period, the more likely it is that employees will procrastinate on choosing their plan(s) and rush at the last minute. For best results consider a two-week period, and a run-up that includes education and outreach.

Helping them prioritize the basics. There are a few areas that they should review to make sure they choose wisely.
Some areas they can focus on include:

Retaining their doctor — Even if you are offering the same plan as last year, it’s a good idea to tell your employees to check the plan to see if their physician or their kids’ pediatricians are on the list of providers. Health plans make changes every year, so it’s important to check.

Getting the financial balance right — Many people end up spending more up-front on higher premiums in exchange for lower out-of-pocket maximums and/or deductibles, when they shouldn’t.

A young, healthy person that rarely visits the doctor may be better off with a plan that has lower premiums and a higher deductible, which they will not likely reach.

Worst-case-scenario calculation — Your employees should understand the implications if they suffer a medical crisis. For a full perspective, they can:

Calculate the total premium they will pay for the entire year (their monthly premium contribution x 12), and add
The out-of-pocket maximum for the plan.

Employee Wellness: The Role of Affordable Medications

In today’s competitive business landscape, employee wellness has become a critical
factor in organizational success. One often overlooked aspect of employee well-being is
access to affordable medications. The ability to obtain necessary prescriptions without
financial strain plays a crucial role in maintaining a healthy, productive workforce.

Affordable medications contribute significantly to employee wellness in several ways.
Firstly, they ensure that workers can adhere to their prescribed treatment plans without
compromising their financial stability. When employees can easily access and afford
their medications, they are more likely to follow their doctors’ recommendations, leading
to better health outcomes and reduced absenteeism.

Innovative Approaches to Medication Affordability
Employers play a vital role in making medications more affordable for their workforce.
By implementing strategic benefit plans, companies can significantly reduce the
financial burden of prescriptions on their employees. One innovative approach is
leveraging international sourcing options through companies like ScriptSourcing, which
can often cut the prices of brand-name and specialty drugs by more than half.

ScriptSourcing, for example, offers a unique business model that aligns their interests
with those of their clients. They only succeed when their clients save money on
prescription costs, ensuring a commitment to shared success. This approach stands
in stark contrast to traditional pharmacy benefit managers (PBMs) that may engage in
practices like spread pricing, which can drive up costs rather than reduce them.
Benefits of International Sourcing

International drug sourcing can provide significant cost-saving opportunities for
employers. By working with reputable partners, companies can access medications at
lower prices while still ensuring product integrity. Some key benefits include:

Zero copays: ScriptSourcing provides zero copays on name-brand maintenance
medications for both employees and dependents.
Free shipping: Prescriptions are shipped directly to employees’ homes with no
shipping or handling costs.
Substantial savings: Companies can save significantly on high-cost medications.
For instance, one company reported saving $24,000 a year on a single
medication through ScriptSourcing.
In conclusion, affordable medications, including those sourced internationally, can be a
cornerstone of comprehensive employee wellness programs. By ensuring access to
necessary prescriptions through innovative approaches like international sourcing,
employers can foster a healthier, more productive workforce while simultaneously
managing healthcare costs and enhancing their reputation as employee-centric
organizations.

Are Your Benefits Enough to See Employees Through a Crisis?

Middle class families — those with incomes of between roughly $50,000 and $100,000 per year — are becoming increasingly reliant on workplace benefits to ensure their financial well-being in case of a disability or critical illness.

Simple health insurance is insufficient to carry the load. The loss of a breadwinner’s or caregiver’s financial contribution through death or disability is often devastating.

A recent survey by benefits provider Guardian indicates that families in this category are struggling when it comes to achieving their financial goals. Of those workers surveyed only half believe they would be able to manage if the household lost an income due to death or illness.

Workplace benefits are critical

According to Guardian’s researchers, the middle-market population is overwhelmingly reliant on the quality and breadth of the benefits they receive at work — over and above cash compensation.

Over 80% of middle-market respondents report that they got their health insurance, disability insurance and retirement plan all through their employer.

Meanwhile, six in 10 have no life insurance in place outside of the workplace. This means that the solid majority of working families are relying entirely on workplace benefits to see them through the death of a family breadwinner.

And in the event of disability ending a breadwinner’s income, the situation is even more dire: Only 7% of the middle market owns any kind of disability insurance protection, outside of what they are able to access via their employer.

Are life insurance benefits adequate?

For young families, the primary role of life insurance is to replace the income of a deceased breadwinner. But many employers cap life insurance benefits at $50,000 — the maximum figure that allows employers to deduct premiums as a workplace benefit under IRC 7702.

The actual need for many of these families is several hundred thousand to a million dollars, and occasionally more. That’s what it takes to replace the income of a worker who earns $50,000 to $100,000 per year until the children are out of college and a surviving spouse is taken care of.

A solution

One solution is to offer voluntary benefits to workers. These include a menu of benefits, such as:

Group life insurance
Group disability insurance
Long-term care insurance
Critical illness coverage

Often many of these benefits can be offered at little or no cost to the employer.

Premium costs are simply deducted from the worker’s wages and forwarded to the insurance company via payroll deduction. In this way, workers can purchase much more coverage and provide protection for their families — and it doesn’t cost the employer a dime.

In some instances, it can even save on payroll taxes. To learn more, call us.

ScriptSourcing: The Most Trusted Name in Savings

In today’s crowded market of international pharmacy vendors, ScriptSourcing stands out by prioritizing aligned interests with our clients. Our unique business model ensures that we only succeed when our clients save money on their prescription costs—it’s that simple. This commitment to shared success drives everything we do.

Decades of Experience and Expertise

Founded by Gary Becker, a veteran in health insurance and risk management with over 30 years of experience, ScriptSourcing leverages deep industry knowledge to deliver innovative solutions. We collaborate closely with benefit consultants, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs) to secure competitive pricing on specialty and brand-name medications, often achieving savings of 25-75% without imposing any administrative or setup fees.

Dedicated Member Advocates

What truly sets ScriptSourcing apart is our team of caring member advocates. These professionals guide group members step by step through the process, ensuring they feel comfortable and confident in managing their prescription needs. Our proactive outreach and monitoring not only enhance the member experience but also contribute to healthier employees and improved workplace productivity.

Comprehensive Health Plan Solutions

ScriptSourcing goes beyond just managing prescriptions; we offer a comprehensive suite of solutions designed to optimize health plans. Our advanced analytics tools help employers identify high-cost claimants, enabling them to make informed decisions about their healthcare strategies. This holistic approach not only maximizes healthcare spending efficiency but also enhances employee satisfaction and retention.

Commitment to Affordability

At ScriptSourcing, our commitment to affordability is unwavering. We provide zero copays on name-brand maintenance medications and offer free shipping directly to employees’ homes, eliminating hidden fees and simplifying access to necessary medications.

In summary, ScriptSourcing’s alignment of interests with clients, combined with our extensive experience, dedicated support team, and comprehensive solutions, makes us the ideal partner for employers looking to effectively manage their healthcare costs while ensuring the well-being of their employees.

Your Last-Minute Open Enrollment Checklist

By now you should be prepared and ready to go for your 2025 policy year employee benefits open enrollment. You should have all your plan documents and have prepared or held presentations for your staff to explain the benefits package and any major changes to plans that you offer.

Employees should be familiar with how to use the enrollment portal and who they should talk to if they have questions.

To ensure success, there are a few things you should do to make sure you maximize enrollment, that your employees have the correct materials and that you are in compliance with the law.

Take an active role — Most of the policy selection is done online, but that doesn’t mean you can’t support your employees and let them know you are there in case they have any questions or are confused about any aspect of the benefits package.

You should want all of your employees to choose the package that best fits their individual needs. To ensure they make the best possible choices and have a successful experience, motivate them to take an active role in their education by encouraging questions and showing them where they can find answers in the online enrollment platform.

Last-minute blasts — You’ve probably sent a few e-mail reminders to you staff, but most certainly some of them still missed those communications. Make sure you send a few extra blasts at different times of the week, like Tuesday at 10 a.m. and another on Thursday at 2 p.m.

You should also have all of your employees’ mobile phone numbers, and be sending them reminder text messages is a sure-fire way to get in front of the ones who may not be as diligent about monitoring their e-mail.

Double-check your plan materials — Do a final review of your plan documents for any necessary updates regarding member eligibility, plan benefits, new vendors and name changes to ensure that the current state of your benefits offerings is complete and accurate.

Also, do a final review of your summary of benefits and coverage (SBC) and your summary plan description (SPD) to make sure they reflect any changes from the prior year. This is crucial as both documents are required under the law.

The SPD may include the elements necessary to meet the requirements of the SBC, but it also needs to be a separate document that can be handed out with respect to each coverage option made available to the participants.

To account for the annual open enrollment window, double-check your open enrollment schedule, deadlines, documents and forms, coverage options and changes, phone numbers, and website and mobile information for contacting resources, statement of current coverage, and plan-specific summaries and rates.

Identify staff that didn’t enroll last year — To make sure you maximize participation and that nobody misses out, run a list of all your staff who didn’t sign up for benefits last year so you can approach them individually and convey the importance of securing health coverage.

While you’re at it, make sure that all of your new hires in the past year have also signed up for coverage and that you didn’t miss them when sending out reminders about open enrollment.

Check compliance with ACA — If you are an “applicable large employer” under the Affordable Care Act, meaning that you have more than 50 full-time or full-time equivalent employees, you are obligated under the law to provide health coverage to your staff that is “affordable” and covers 10 essential benefits.

There is a figure for what is considered affordable, which changes every year. For your plan to be considered ACA-compliant in 2025, it must not cost an employee more than 9.02% of their household income.

The takeaway

To ensure maximum enrollment it pays to plan ahead and also focus on educating your staff about the importance of their group health plan and why it’s so important to choose a plan that is right for them and that is within their budget in terms of premium-sharing and out-of-pocket costs.

The key regular communications and having an open-door policy so individual employees can ask questions in private.

The Hidden Costs of Prescription Medications: What Employers Need to Know

Prescription drug costs have become a significant burden for employers providing health benefits to their employees. As these expenses continue to rise at an alarming rate, companies are increasingly seeking ways to manage and reduce their healthcare expenditures.

One of the primary culprits behind inflated drug prices is the complex system of pharmacy benefit managers (PBMs). These middlemen often employ tactics that drive up costs rather than reduce them. For instance, PBMs may engage in “spread pricing,” where they charge employers more for medications than what they pay pharmacies, pocketing the difference. They may also retain rebates from drug manufacturers instead of passing those savings on to employers and patients.

The lack of transparency in the current system makes it challenging for employers to identify and control their prescription drug expenses. Bundled insurance packages often obscure the actual costs of medications, limiting employers’ ability to negotiate better prices or tailor drug formularies to their workforce’s specific needs.

However, there are strategies employers can implement to mitigate these hidden costs. Unbundling prescription drug plans from traditional insurance packages can provide greater transparency and control over expenses. This approach allows employers to negotiate directly with PBMs, customize formularies, and leverage data analytics to make informed decisions about their prescription drug coverage.

Alternative prescription sourcing companies like ScriptSourcing, LLC offer a powerful solution for reducing the cost of expensive medications. By leveraging both international and domestic
sourcing options, these companies can often cut the prices of brand-name and specialty drugs by more than half. This approach stands in stark contrast to the strategy promoted by some large agencies, which focuses on pursuing rebates. The rebate-chasing method simply cannot match the substantial savings achieved through alternative sourcing vendors, making the latter a more effective choice for those seeking to significantly lower their medication expenses.

To truly address the issue of rising drug costs, employers should also advocate for policy changes. Supporting legislation that requires PBMs to be more transparent and accountable can help create a more competitive and fair market for prescription drugs.

By understanding the hidden costs associated with prescription medications and exploring alternative solutions, employers can take proactive steps to control their healthcare expenses while ensuring their employees have access to necessary medications.

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