Obtain Ongoing & Continuous Services To Ensure Lower Costs

Our consulting firm provides ongoing services to Plans to enable Plans to monitor and continually decrease and control their prescription coverage costs. Our services include the following:

  • Reviewing the client’s Invoices to verify they are appropriate
  • Regularly conducting in-depth claims data analyses to understand plan beneficiaries’ drug utilization and to recommend changes in drug coverage and programs
  • Creating and regularly updating a customized Formulary to ensure our clients do not rely on their PBM’s “standard” Formularies (which virtually always favor many high-cost drugs given PBMs’ conflicts of interest)
  • Creating and regularly updating customized Prior Authorization/Step Therapy/Mandatory Generic and Quantity Limit Programs to ensure our clients do not rely on PBMs’ “standard” Programs (ditto)
  • Monitoring the PBM’s satisfaction of all contract pricing terms and guarantees
  • Regularly re-negotiating pricing terms and guarantees, by taking advantage of our contract’s quarterly and annual “Rights to Renegotiate”
  • Periodically carving out certain Specialty Drugs and relying on alternative specialty pharmacies to dispense said drugs at lower costs, and thus taking advantage of our contract’s “Carve-Out Rights”
  • Reviewing and analyzing the utility of all newly approved FDA drugs – and the extent to which existing drugs provide the same therapeutic value at lower cost – and providing recommendations to our clients on the new drugs to cover, and those to exclude from coverage
  • Monitoring all brand drugs that lose their patents – and the prices of newly available, chemically identical generic drugs as they decrease over time – to make recommendations on when to block the higher-cost brand drugs
  • Conducting regular “Price Increase Analyses” to determine the price increase of every drug on the market, and making recommendations to our clients to enable them to respond quickly to drugs with extreme price increases

Our firm’s ongoing and continuous services have enabled our clients – and Coalition Members – to reduce their costs initially by 15% to 30%, depending on the number of recommendations our clients adopt, and thereafter to maintain their lower costs over time.