When a plan beneficiary brings a prescription into a pharmacy, the pharmacist enters information into the pharmacy computer identifying the beneficiary’s name, prescription and plan ID number, as well as the prescription that needs to be filled.
Though few know of their existence, switch operators – also known as clearinghouses – play a key role in drug dispensing. Switch operators serve as intermediaries between pharmacies on the one hand and PBMs (or insurance companies) on the other. Therefore, you need to pull back the curtain, understand their machinations, and respond. If your response to all these questions is negative, we urge you to read on, because switch operators are like the Wizard of Oz: They’re hidden behind a curtain and being paid by manufacturers to end-run your cost-savings efforts. Plan Administrators: Have you ever heard of “switch operators”? Do you have any idea what they do? Most important, do you realize that drug manufacturers are surreptitiously paying switch operators to interfere with your copayment and deductible structures and likely causing your plan (and all other plans) significant financial harm?
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