2016 shed light on the pharmacy benefits industry and the blurred process behind drug pricing. Knowledge is the first step toward transparency, and we move into the New Year with hope that the recent attention will bring more clarity to PBM practices - eventually leading to meaningful change.
So far, in my series “Weathering the Rx Storm,” I’ve reviewed how to improve your PBM contract, how to develop a strong formulary & effectively manage benefits design and how to engage employees in new models. If you haven’t been following my series, then I recommend reading the first four blogs for a well-rounded look at saving money on pharmacy benefits.
Today, in the final blog of this series, I’ll focus on the advantages of carving out mail order pharmacy, specialty pharmacy and rebates and the immense amount of savings available in these areas.
In this blog series, I’ve discussed ways to review and improve your PBM contract, as well as achieving the best financial value from your benefit design, formulary, and specialty Rx. The next step is to help your members make informed decisions on what medications they should use, where they purchase them, and what cost effective alternatives exist. Making the right choices, with guidance, can help lower out of pocket costs and improve employee adherence to medication treatments, optimizing their health.
When reviewing a PBM contract and benefits plan, there are a few areas I always analyze to ensure maximum savings are being achieved for my clients. Areas of concern are formularies, benefits design and specialty/mail pharmacy.
If you’re reading this blog, you’re most likely aware how cumbersome and intricate pharmacy benefit management (PBM) contracts can be. Negotiating these contracts properly takes a deep understanding of PBM business practices and definitions, industry-specific language, and pricing structures.