PBIRx's Approach To Managing Pharmacy Benefit Costs

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

In a time where the cost of prescription medications and pharmaceutical services continues to rise, there is a pressing need for them to be controlled. Did you know that records from 2014 suggest that for more than half of today's employers (77% to be exact), pharmacy benefit costs made up 16% or more of their total healthcare budgets? And although 16% might not seem like such a significant number to some right now, the reality is that the total percentage of healthcare costs dedicated to pharmacy benefits is only going to continue to grow as the cost of services continues to rise.

As one of Connecticut's top pharmacy benefit consulting firms, our goal is to provide entities with cost saving solutions that allow them to offer desired healthcare services at the lowest possible costs. To do so, we have created a proprietary tool known as our Specialty Drug Toolbox. The following is a brief look into each stage of this valuable tool that we use with each and every one of our clients:

1. Price: To determine whether or not you are paying a fair price for your pharmacy benefit plan, we consider the specific discounts and rebates that are available for generic drugs, biosimilars and limited distribution drugs. This way, we can figure out whether or not your plan offers medications and services at the right price.

2. Channel Management:  Once we are familiar with the discounts and rebates you are entitled to, the next thing we look at is the various channels that can offer them. Since rebates vary based on certain dispensing facilities, we narrow down which ones work best for your plan.

3. Clinical Review and Management: Next, we focus on your plan from a clinical perspective. That means we analyze how your plan is designed and compare it to clinical data to determine if any additional savings are available for positive healthcare outcomes.

4. Clinical and Pharmacoeconomic Outcomes: Finally, the last stage of our analysis includes studying how you are/should be managing patient disease states. This part of our approach ultimately looks at how both the patient and the disease will be cared for as the patient starts to use the services they are entitled to through your pharmacy benefit plan.

Now that you are more familiar with our approach and how we can work with you to control your pharmacy benefit costs, it's time to get started. For more information on our proprietary Specialty Drug Toolbox and how it can benefit you through our pharmacy benefit consulting and auditing services, contact us at (888) 797-2479 today.

PBIRx's Proprietary Specialty Drug Tool Box

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

 

As experts in the pharmaceutical field, PBIRx thrives on providing the best pharmacy benefit solutions to any entity that offers benefits to its employees or members.The demand for high cost oral and injectable specialty drugs continues to rise with existing drugs getting FDA approval for new indications, which dramatically increases utilization. Between increased utilization, new specialty drugs launched and manufacturers increasing prices several times a year, specialty drugs are now representing up to 40% or more of the total pharmacy benefit spend.

Management of not only the cost of the specialty drug, but also effecting a positive and lowest cost healthcare outcome requires many components beyond just the actual specialty drug discount provided by the PBM. That is why at PBIRx, we have developed a proprietary Specialty Drug Tool Box that is used with every client to manage the growing segment of the pharmacy benefit.

The following provides some insight on our Specialty Drug Tool Box with various components to consider in optimizing management of rising specialty drug costs:

1. Price: First and foremost, it is important to know and understand about specific discounts and rebates that are available for various specialty drugs including generics, biosimilars and limited distribution drugs.

2. Channel Management: Drug discounts, member management services and rebates vary based on the specific dispensing facility i.e retail pharmacy, PBM owned specialty pharmacy, doctor's office, in house hospital pharmacy, infusion center and approved limited distribution specialty pharmacy.

3. Clinical Review and Management: Significant savings can be achieved beyond the drug discount by using various clinical algorithms to identify and implement programs resulting in overall low cost positive healthcare outcomes.

4. Clinical and Pharmacoeconomic Outcomes: Lastly, once a plan is in place it's time to make sure you are managing the patient's disease state to include coordination of care, medication adherence and disease management.

For more information on our Specialty Drug Tool Box or how PBIRx can help you manage your pharmacy benefits, visit us at www.pbirx.com or contact us at (888) 797-2479 today!