If your Plan wants to decrease and control its prescription coverage costs, your Plan needs three types of expertise: Legal, financial and clinical.
Legal – because the single document that controls your Plan’s costs is your PBM contract. If you don’t change your contract’s terms – and eliminate all contract “loopholes” that are driving up your costs – you can’t decrease and control your costs.
Financial – because after you implement an airtight PBM contract, you need to analyze your claims data to (i) determine whether your PBM is categorizing drugs accurately; (ii) assess whether your PBM is satisfying your contract’s pricing terms and guarantees; and (iii) analyze the costs of every drug so you can determine whether and how to alter your drug coverage to decrease and control your costs.
Clinical – because you can’t allow your PBM, which is plagued by conflicts of interest, to decide the drugs to cover and exclude. Nor can you rely on your PBM’s “standard” Formularies or “standard” Prior Authorization, Step Therapy, Mandatory Generic & Quantity Limit Programs, given your PBM’s obvious conflicts of interest. You need independent expertise to make these decisions. Moreover, to control prescription coverage costs your Plan needs to respond to numerous marketplace changes, including new-to-market drugs, brand drugs losing their patents and the ever-increasing prices of many drugs.
Many consulting firms are entirely devoid of legal, financial and clinical expertise: They employ nothing but marketers and salesmen. Other consulting firms only have expertise in one or two of these areas, but are entirely lacking the other necessary expertise. Our firm provides cutting-edge expertise in all three areas.
Retain Pharmacy Benefit Consultants, and you’ll gain unparalleled expertise. As a result, your Plan will dramatically decrease and thereafter control its costs.