Payers are faced with many challenges in the quest to provide quality healthcare while mitigating the continually rising cost of medications. These challenges aren’t simple. There are a myriad of things to consider while making every day decisions on behalf of the member, such as mysterious new-to-market drugs, what to do when new generics are made available, and the impact of not-so-transparent manufacturer rebates and coupons. Additionally, there’s the ever-growing specialty medication market that has dominated new drug approvals over the past decade while increasing drug spend considerably. Payers must take all of this into consideration, weighing costs, clinical effectiveness and impact to the plan—which is no small task!
This constant flux of medications can be confusing, and really requires a pharmacy care strategy specific to the payer’s member population. But that leads to another question – which Pharmacy Benefit Manager (PBM) can help me with these challenges? Most often, the selection of a PBM partner comes down to one thing: the price the plan will pay for the drugs its members use. While looking at the lowest cost provider sounds like the obvious solution, it actually isn’t that simple.
Whether you’re a payer or a consultant advising payers, we’ve compiled some key questions you should ask when determining your current pharmacy care strategy and how you can balance care and pharmacy costs:
- Do you have a coverage strategy in place for new-to-market drugs?
A comprehensive formulary approach includes programs to help control costs while ensuring appropriate access.
- Do you cover medications that have little to no clinical value compared to currently available medications?
Expensive non-essential drugs needlessly inflate plan costs. A non-essential drug program can save plans as much as 60% per prescription by replacing these medications with readily available lower-cost alternatives.
- Do you have a copay benefit structure in place that maximizes copay assistance for your members?
Copay assistance programs can save up to 97% of member out-of-pocket (OOP) expenses and 7%-10% on bottom-line plan savings.
- Do you have a comprehensive strategy in place to manage specialty medication costs and plan impact?
Help members stay adherent to their specialty medications while keeping plan expenses down by dynamically managing your plan design.
- When did you last review your PBM contract and discuss real cost savings strategies?
Now is the time. Optimize all aspects of plan performance and the patient experience with innovative solutions for better clinical and financial outcomes.
Contact us today to optimize your plan's pharmacy care experience and consistently achieve better patient and plan outcomes.