Pharmacy Benefit Management Consulting

With pharmacy costs accounting for nearly half of total employer health care spend, it’s more important than ever to proactively manage pharmacy costs by taking greater control of PBM contract terms. Our assessments are the most effective way to determine if a current PBM contract has shortcomings or if a PBM is failing to meet its responsibility to provide the highest quality pharmacy benefits at the lowest cost.

The no-risk, no-obligation review includes:

• Review of your current PBM contract and your most recent 12-months of claims data
• A promise of no disruption to your current PBM relationship or plan members
• Transparent and unbiased findings — if we can’t help you save, we don’t get paid

We take a consultative approach to customizing pharmacy benefit plans that strike a balance between cost containment, patient utilization and accessibility, and optimal patient health outcomes. Our pharmacists identify the most appropriate plan design options, clinical programs, and specialty drug alternatives to help you meet your business goals.

Services and benefits include:

• Customization of formulary to drive to lowest net cost utilization
• Management of specialty drugs to minimize impact of high-cost claims
• Maximization of generics and optimization of rebates to save you and you plan members more
• Updates on future impact of pharmacy trends and pharmacy benefit legislation

Our team leads the day-to-day account management of the vendor relationship and holds the PBM accountable for operational excellence. Our vendor-agnostic approach allows us to deliver pharmacy benefits solutions that match clients with the services they need — at the best pricing possible.

Services and benefits include:

• Managing the PBM RFP process and negotiating the final agreement
• Navigating the ins-and-outs of pricing and contract complexities while protecting client interests at every turn
• Vetting and sourcing PBMs when change is necessary
• Conducting annual reconciliations and monitoring client-specific performance guarantees

Innovative pharmacists continuously monitor benefit program performance and pharmacy claims, leveraging data and their practical expertise, clinical and financial analysts provide actionable insights to make sure clients receive the greatest value possible from their pharmacy benefits investments.

Services and benefits include:

• Regular reviews of pharmacy claims data and reporting on employee health risks and utilization trends
• Evaluation of high-cost drug claims on medical plan for possible cost-savings solutions that minimize member disruption and maximize health outcomes
• Negotiation direct with PBMs and health care providers when necessary to implement solutions

Our team of clinicians and analysts manage risk by continuously reviewing the pharmacy claims that come through your medical plan. They proactively identify opportunities to mitigate financial risk to the organization and improve the health of plan members — with little to no member disruption.

Services and benefits include:

• Regular reviews of medical claims data and reporting on employee health risks and utilization trends
• Analysis of short- and long-term risk to the plan as well as opportunities to optimize treatment cost without impacting member care or health outcomes
• Direct negotiation with health care providers and carriers when necessary to implement cost-savings solutions