Pharmacy Benefit Management

There was a time not all that long ago, when the Pharmacy component of a medical benefits plan got very little, if any attention. Those days are gone. At least they absolutely should be. It used to be that the pharmacy costs accounted for maybe 15-20% of the overall plan. Not anymore. The trend escalations now have reached closer to 30%, and climbing. Much of this has to do with terrific advancements in what is known as “specialty” drugs…..and “orphan” drugs.

However, another troubling trend has been for insurance companies to structure their offerings which are inclusive of a number of different pockets of profit for them. We spend a lot of time identifying these areas and negotiating far better terms for our clients. It is not just the dollars associated with rebates, spreads, processing fees and disbursement fees and others, but we also look to amend the contract language to ascertain the plan functions, and the claims are adjudicated according to terms agreed to.

Ideally, this can all be achieved with the same provider as the medical, but if not, we work with some highly regarded professional PBM organizations and will take an unbundled approach to achieving the desired results.

Additionally, there are a number of different cost-saving techniques that can be easily incorporated within your existing plan that many employers have been utilizing in recent years. The dollar savings has become very meaningful.