What is so different about Pharmacy BenefitDirect?

Differentiating Feature	Traditional PBM	Pharmacy BenefitDirect
Ownership	Traditional PBMs are publicly traded and operate on high overhead. They are pressured to increase revenue through rebates and other means that conflict with managing the cost.	BenefitDirect is privately held and operates on low overhead. Our only focus is managing your cost, and our only revenue source is a fixed administrative fee.
Integration	Traditional PBMs own and operate parts of the prescription delivery system, such as mail order, retail pharmacy and/or manufacturing. As a result, they tend to drive referrals to their owned delivery components. This can create over-utilization and/or increased expense.	BenefitDirect does not own any components of the prescription delivery system. Therefore, we have no incentive to over-utilize these components or to prefer drugs that are more expensive. We focus on the most appropriate and cost effective use of all services.
Ingredient Cost	With a traditional PBM, ingredient cost tends to be higher because mail order is over-utilized, expensive brand drugs are preferred, network discounts are retained by the PBM, and savings are not shared with the payer/client.	BenefitDirect reduces ingredient cost by returning savings to the payer/client.
Rebates	Traditional PBMs maximize rebates by preferring the most expensive brand drugs; then, they retain a percentage of the higher rebate as revenue.	BenefitDirect seeks balance in our rebate program by developing formularies that favor payer/client net cost. We collect a fixed fee for this service to avoid a conflict of interest with the payer/client.
Network	Traditional PBMs retain up to 3% of trade name discounts and up to an average of 30% of generic discounts as a revenue source.	BenefitDirect passes through the entire contract rate that is negotiated with the network. The rate is also passed to the member when it is less than the copay.
Mail Order	Traditional PBMs typically own the mail-order service; as a result, they encourage over-utilization of this service. When you consider the loss of co-pay and product waste, mail order is not always the most cost effective option.	BenefitDirect seeks appropriate use of the mail-order service by recommending benefit designs that balance mail-order use for cost effective outcomes.
Fee for Service	Traditional PBMs seek multiple channels to make money, such as payer/client administrative fees, retained pharmacy discounts, retained rebates, data wholesaling, manufacturer programs, etc. PBMs have to please many customers, the least of which is the payer/client.	BenefitDirect has only one revenue source – the fixed administrative fee paid by the payer/client for cost management services. Our only focus is the payer/client’s needs.
Data Control	Traditional PBMs are reluctant to share utilization experience data with the payer/client. They limit the payer/client’s access to this data.	BenefitDirect views itself as the payer/client’s vendor; as such, the utilization experience data belongs to the payer/client. This data will be shared with the payer/client upon request.
Total Cost	Many traditional PBMs are creating trend lines for the industry that are fast approaching 20%.	BenefitDirect generates results below trend based on a cost focus and resultant savings that are returned to the payer/client.