What We Do

Prescription drugs are one of the most complex aspects of employee benefits. To maximize your drug program’s effectiveness and minimize the drain on your bottom line, our team helps you manage the impact of escalating pharmacy benefits costs by increasing the transparency and terms of Pharmacy Benefit Management (PBM) contracts.

We find savings 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.

HOW WE’RE DIFFERENT

We offer the most experienced pharmacy benefits consulting team of any Indiana-based benefits advisory firm. Our team of Certified Pharmacy Benefit Specialists (CPBS) conducts PBM contract assessments to identify cost saving opportunities that can translate into additional revenue for your organization. With our experience we’ve been able to save our clients an average of 50% on their Rx benefits costs – without shifting costs to employees and with zero or very few disruptions to their benefits plans.

Pharmacy Benefits Consulting

Services

Uncover Found Revenue Through Savings

CONTRACT HEALTH ASSESSMENTS

Our CPBS team will review your PBM contract to assess its strength and transparency and assign a score from A to C. With your contract health score in hand, our team audits your entire Rx benefits program to identify cost-saving opportunities.

SOURCING & CONTRACTING

Once the contract assessment is completed and action plan determined, the team sources better pricing from the current or new PBM companies. The team also ensures the commitments made are written into a strong, transparent PBM contract.

IMPLEMENTATION

Working with the PBM, third-party administrator and your team, we will guide 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.

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.

Pharmacy Benefits Consulting

How Much Could You Save?

*Depends on your current contract and benefit design, covered population, medication mix and current market pricing.

  • Input total expense for pharmacy claims in given year.
  • Please enter a number from 10 to 30.
    Input potential savings percentage (Apex Pharmacy Benefits clients may expect 10-30% pharmacy savings in the first year).

High-Cost Rx Event Recap

Global Rx Experts Share Knowledge

Employers understand that a diagnosis of cancer or a debilitating chronic disease among their workforce could result in the need for lifesaving, high-cost medications that can wreak absolute havoc on their organizations’ finances. Event attendees wanted to be better informed — and better prepared — for managing their risk. View the page linked below for thought leadership and practical tips from executives from Eli Lilly, Cigna/Express Scripts, SwissRe and Apex.

See More
Pharmacy Benefits Consulting

PHARMACY BENEFIT SAVINGS

$150,000 Potential Reduction in Rx Claims

As a self-funded organization, the rising cost of providing healthcare benefits was creating a financial challenge for a company with several employees who required high-cost drug regimens. A potential savings of 43% of the previous year’s Rx spend was identified.

View Case Study
Pharmacy Benefits Consulting

Recent Posts

  • September 20, 2021

    Wee Dose of Radical Transparency | EP 14

    It might seem like Alphabet Soup, but knowing what NDC and J-Code means is an absolute must. Essentially, both are used to determine how your medical procedures or medications are billed to your health insurance. However, there are significant differences …

  • August 18, 2021

    Wee Dose of Radical Transparency | EP 13

    You’re probably getting ready to review your pharmacy benefits plan and how much you’re spending. How much you spend depends on your PBM contract, which can be anywhere from radically transparent to opaque. Consider these three tips to help lower …

  • August 10, 2021

    Better Benefits in 90 | 3 Questions to Ask Your PBM

    It’s always important to ask questions to your PBM to make sure you’re getting the best benefit possible from the services. While we can come up with up to 10 different questions, we know there are three you absolutely should …