Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
With prescription drug prices increasingly rapidly along with PBM profits, you may be starting to consider the options you have when it comes to managing your company's pharmacy benefits. If there is one thing we know for sure, it is that you should meet with an expert consultant and auditor like ourselves to discover if your current health care solution is working in your favor. Specifically when it comes to specialty drugs, our team has created a proprietary Specialty Drug Tool Box that is used to help with optimizing management of rising specialty drug costs; take a look at the components of it below.
Step 1: Price
In managing your pharmacy benefit plan, you must be aware of the specific discounts and rebates that are available for certain specialty drugs, including generics, biosimilars and limited distribution drugs. Some questions to consider at this stage are:
- Does your PBM contract state different discounts for different limited distribution drugs?
- Can your PBM provide an updated specialty drug list with current discounts of the new drugs launched?
- Does your PBM provide a per prescription rebate, a per brand prescription rebate or 100% of the actual manufacturer rebate for specialty drugs?
- Are you sharing in the lower cost provided to the PBM for drugs with Value Based Contracts providing discounts/rebates back to the PBM if there is NOT a positive healthcare outcome?
- Do you work with an expert that can identify when a PBM prefers a higher cost specialty drug over its significantly lower cost generic equivalent because the PBM receives rebates?
Prior to making any decisions about specialty drugs as they relate to your pharmacy benefit plan, you must know about the cost effective solutions that can be applied, the robust pipeline, price increases, new generics and biosimilars, new rebate opportunities, etc.
Step 2: Channel Management
Depending on your dispensing facility (for example, a retail pharmacy or doctor’s office), you may see a variation in the management services and rebates available to you. Before you make a decision on which you will choose, you need to look into the differences to determine a facility that has the most benefit to both the plan and your members. At PBIRx, we will work with you to analyze each of your options to find the one that best suits your needs.
Step 3: Clinical Review and Management
The third stage of our Specialty Tool Box has to do with utilizing proprietary clinical algorithms to discover programs that result in low-cost health care outcomes. At this point, we will take a closer look at your plan’s design to learn if there are other cost saving opportunities available to you, not just those that include a discount on certain drug costs. PBMs work very closely with drug manufacturers whose miscellaneous fees and rebates provide significant profit margins. Those profit margins incentivize formulary decisions and not necessarily the plan’s costs. PBIRx has no ties to a drug manufacturer and therefore, is independent of decisions based on rebates that are not shared with our clients.
Step 4: Clinical and Pharmacoeconomic Outcomes
Once your pharmacy benefit plan has been analyzed by PBIRx with new recommendations and associated savings/member disruption, if any, the next step is to confirm the management of patients’ disease states. Here, we help by going over all of the specialty drugs chosen for your plan and figuring out how patients and their diseases will ultimately be cared for and managed. Many PBIRx clients value our proprietory Specialty Drug Adherence programs, for which Compliance programs are implemented and member’s behavior changes, along with associated savings is reported back.
To learn more about our Specialty Drug Tool Box and how we can apply the strategies within to assist with your pharmacy benefit plan in 2016, please give us a call at (888) 797-2479. Additional information about each of our individual services is also available on our website.