Under pharmacy cash discount card programs it is not uncommon for PBMs to experience a claim adjudication reversal rate of up to 50%.  When adjudication circumvention occurs, neither the patient nor the PBM have any way of knowing it has occurred at the point-of-sale.

 

This deficiency leaves the patient vulnerable to:

 

• Paying more than their PBM's network contract rate, and

 

• An inability to receive concurrent Drug Utilization Review on all prescriptions - thereby making them susceptible to drug therapy related problems which otherwise could have been detected and avoided.

 

This deficiency leaves the PBM vulnerable to:

 

• A high attrition rate.  Pharmacies can easily switch patients to their loyalty discount cards by representing to the patient that their card provides them a better (less expensive) price. 

 

• A significant loss of revenue.  PBMs do not receive revenue when pharmacies circumvent the adjudication process.

 

However, PBMs that utilize the MBRx medical banking solution, Patient Driven Rx℠, are inoculated against efforts to switch the patient to a different card, once patients understand:

 

• There is a current industry-wide deficiency for the pharmacist can disregard the price they are supposed to charge the patient and instead establish a higher price without the patient’s knowledge, and 

 

• Patient Driven Rx℠ is the only safeguard available to protect them from the vulnerability of being overcharged.