As a team of benefits strategists, we work hard every day to make sure we’re exceeding client expectations and providing the most innovative and value-generating plan designs and advisory services.
If you’re a self-funded organization using pharmacy benefit management (PBM) services, have you ever wondered exactly how much your company is paying for these services? Have you taken that extra step to go deeper than a pharmacy benefits or claims review to examine the fees you’re paying the PBM to manage your program? There could be complex language within your PBM contract and hidden extra costs your PBM is charging you. But without the tools and knowledge to know what to look for, you may be missing some important details that could greatly reduce your costs.
One of the most effective ways to identify potential pitfalls within your PBM contract is by enlisting the expertise of a Certified Pharmacy Benefits Specialist (CPBS). Why does this designation matter and what can a CPBS do for you?
Knowledge beyond the basics
There are many people who profess their expertise about pharmacy benefits. However, when probed further, they’re missing a comprehensive understanding of pharmacy benefits and all the factors contributing to the cost of providing medicine for employees.
Individuals who have earned the CPBS designation have gone through a rigorous training program and are well prepared to use their knowledge to help employers better understand PBM contracts and find savings for their organizations. CPBS professionals are trained far beyond just knowing the basics of pharmacy benefits. They’ve learned how drugs flow through the distribution system, and they know where cost and value are added or subtracted from the equation before reaching employers.
“More than ever before, employers will need to access the expertise of someone who’s a pharmacy benefits specialist, someone who knows how the money flows, where the costs are added, and where the value is taken out of the system. That’s where a CPBS can provide the greatest value to employers.”
School of pharmacy accredited
The CPBS certification goes much deeper than many other pharmacy benefit-related training programs. It’s the only pharmacy benefit-related program that’s accredited by a pharmacy school at a university. A CPBS-certified professional not only represents on-the-job training and years of experience; they’ve been thoroughly trained and have passed an exam to confirm their knowledge meets the school’s accreditation standards.
Analysis that leads to savings
If you’re only relying on the reports a PBM sends to you, how do you know if they’re adhering to the terms of your contract? A CPBS gets into the details, looking at the price of a drug, confirming whether it was coded as generic, brand or specialty and determining adherence to the definitions in the agreement. They will also look at the discount rates and calculate the total net cost.
Many CPBS professionals use data analysis to ensure the PBM is doing what they say, and often this knowledge can lead to savings for employers. The Medi-Span Price Rx pricing database is one such tool and can be a differentiator when it comes to savings. Medi-Span subscribers, like Apex, have access to the same data that PBMs, drug companies and pharmacies use to administer pricing. With access to this resource, a CPBS can confirm that the signed contracts are correctly being administered.
From advocates to educators
A CPBS can be utilized as a consultant to help you either negotiate an improved contract with your current PBM or find a PBM who will give you a better contract. They can also review every claim for you, reprice it and check it against the contract terms to make sure the PBM is not taking advantage of you.
Beyond providing consulting services, one of the most important things a CPBS can do is educate business owners, HR professionals and finance leaders on how to be better consumers of pharmacy benefits. Whether it’s through educational programs, pharmacy benefits teaching labs or by simply sharing best practices, a CPBS is here to educate in whatever way they can.
Removing the burden
In the last 10 years, pharmacy benefit costs have steadily increased and are now growing at a much higher rate than medical benefit costs. For many Apex clients, pharmacy benefit costs make up anywhere from 15% to 45% of their total healthcare benefit spend. This is much higher than national averages.
As medication costs continue to skyrocket, it will be crucial for employers to focus on reducing pharmacy benefit costs. One of the first steps involves reviewing your PBM contract. However, this task can be overwhelming – and most employers don’t have the time or desire to sit down and pore through a stack of contract language. If you fall into this category, a CPBS certified professional could be the best solution to take this burden off your shoulders.
If you need help reviewing your PBM contract, contact our ApexRx CPBS team at ApexRx@apexbg.com for a complimentary assessment.
Expand Your Pharmacy Benefits Knowledge
The ApexRx CPBS team has helped numerous clients reduce their pharmaceutical costs by 15 to 45%. Read about one of our most recent successes here.
Learn more ways to reduce the burden of high-cost medications by registering here for our November 13 event, “A Prescription for Managing the Impact of High-Cost Medications.”