Pharmacy Benefits Consulting
The benefits you deserve at the highest quality and lowest cost
Pharmacy Benefits Lab:
Uncovering Hidden Revenue in Your PBM Contract
Tuesday, February 4, 2020 | 8:30am to 1pm
Certified Pharmacy Benefits Specialists Uncover Hidden Revenue Sources in Your PBM Contract
The ApexRx Pharmacy Benefits Consulting program was established to help employers manage the impact of escalating pharmacy costs and increase cost transparency, particularly in their Pharmacy Benefit Management (PBM) contracts.
We are the only Indiana-based benefits advisory firm to employ a team of Certified Pharmacy Benefit Specialists (CPBS) that conducts PBM contract assessments to identify cost saving opportunities that can translate into additional revenue for your organization.
We find these savings – not because PBMs are being transparent – but because we know where to look. And we know how to ensure discounts, rebates and other manufacturer-derived revenues pass through to the ultimate funders of healthcare – the employers – instead to the PBMs’ profit margins.
With our experience we’ve been able to save our clients 15% to 45% on their pharmacy benefits costs – without shifting costs to employees. And typically with none or a few, very minor disruptions to their benefit plans.
Contract Health Assessments
ApexRx services begin with a contract review to identify the strength and transparency of your current PBM contract. After review we will assign a score. Then with your contract health score in hand, our team assesses your benefit design, along with your company objectives, to present cost-saving options. WATCH VIDEO TO LEARN MORE
Sourcing & Contracting
Once the contract assessment is completed and action plan determined, the ApexRx team conducts PBM sourcing to obtain improved pharmacy benefit pricing. The team utilizes elements of traditional market re-pricing, RFPs and reverse auction techniques. The team also ensures the commitments made during sourcing are written into a strong, transparent PBM contract.
Working with the PBM, third-party administrator and your team, the ApexRx team guides your plan implementation from set-up to go-live. We work with you and your employees to manage the transition and minimize any potential disruption.
Ongoing Customized Monitoring
Monitoring is a crucial tool to ensure you get what you pay for. We offer a range of customized reporting, analysis, market check/monitoring, and audit services to make sure the pricing and performance of your pharmacy benefits remain aligned with the contract terms.
Realize 15% to 45% in Pharmacy Benefits Savings
*Depends on your current contract and benefit design, covered population, medication mix and current market pricing
ApexRx Case Study
Annual Savings – $150,000
(Projected 43% decrease from previous year’s Rx claims spend)
As a self-funded organization, the rising cost of providing healthcare benefits was creating a financial challenge for this small employer. Several employees required high-cost drug regimens to treat conditions such as rheumatoid arthritis and other autoimmune diseases. Their prior year pharmacy claims spend was $350,000
Interested in Learning More?
Contact the ApexRx team at ApexRx@apexbg.com.
The ApexRx team will complete a free contract assessment and highlight areas of opportunity for your company.
Given the projected growth of traditional and specialty pharmacy expenses, employers should be educated and work directly with their PBM to ensure appropriate use according to best practice guidelines. Employers should strive for a relationship that eliminates wasteful and duplicative spending, ultimately delivering the best outcomes at the lowest net cost. The Certified Pharmacy Benefits Specialist (CPBS) designation serves as a foundation for achieving maximum value from pharmacy benefits management services and ensures that each Apex Benefits consultant is an adept steward of PBM services.