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Four Strategic Considerations for Successfully Insourcing Pharmacy Benefits

June 26, 2018

How to Take Control of Your Drug Costs, Member Experience and Compliance Measures 

If one thing is constant in today’s complex healthcare landscape, it’s change. New alliances and mergers are being announced between health plans and pharmacy benefit managers (PBMs) at a rapid pace. More than ever before, it’s clear the options are narrowing.

Due to rising drug spend and a complicated legislative environment, health plans are looking for more control over the total patient experience in order to manage costs. Some recognize they can improve costs and better manage their medical loss ratio by managing aspects of the pharmacy benefit themselves. Others are looking for a partner to do more, but may be apprehensive about giving up too much control or fear losing independence and flexibility.

Health plans are looking to their pharmacy partners to ensure all pieces of the member healthcare experience are integrated. In addition, the need to be nimble and respond to external forces, such as legislation and the growing drug pipeline, is critical. But will your PBM provide the level of customization your plan needs to rapidly adapt?

Below are four considerations to help you effectively evaluate your plan’s ability to support your strategic approach to pharmacy benefit management:

  1. Control – The control you seek can come in the form of plan design, patient experience, or monitoring and oversight programs. Customized formulary options, clinical programs, and Pharmacy and Therapeutics (P&T) support should be available to meet your unique requirements, along with the ability to connect and leverage pharmacy data to your enterprise care teams.
  2. Transparency – Do you know what you are spending on the services you receive? Providing clarity as well as visibility into all aspects of drug pricing, from rebates through administration, enables informed decision making.
  3. Value – The right partner can provide savings through improved efficiencies from combined operations, as well as provide guarantees that matter most. Effectively managing the pharmacy benefit can also provide an additional source of revenue.
  4. Compliance – A partner with a deep bench of experience can be an extension of your own compliance team. Ensuring an effective compliance program with the ability to customize monitoring and oversight can deliver a better member experience and help control costs.

As you explore your options, you may find that there are fewer choices for your health plan’s unique requirements. New mergers and alliances are producing complex companies, making it difficult for them to be flexible and provide the customization to meet your needs. There is a ‘right size’ partner where the capabilities, programs and tools are comparable to a larger organization, but with the flexibility to adapt. The right partner can provide customized programs and solutions that meet the needs of your member population.

EnvisionRx offers visibly different options for managing pharmacy benefits. Your plan may need a suite of fully outsourced solutions, full insourcing support or services on an à la carte basis. The PBM you select should offer benefits to fit your cost, administrative, programmatic and monitoring needs, while serving as an integral part of your team. This is possible if you take time to evaluate your strategic approach to pharmacy benefits while giving consideration to the control, transparency, value and compliance support you need. 

See how we helped this health plan save $42 million and improve member outcomes.

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