April 24, 2018

Four Prescription Benefit Saving Strategies You May Not Know About

One of my most important roles as Chief Clinical Officer at Artemis Health is helping our clients find prescription savings using data. It’s an increasingly important component of any self-insured employer’s benefits strategy. With prescription costs climbing faster than inflation, there are a number of methods benefits professionals are using. Many you’ve already heard about (or even adopted), but some you probably haven’t.

I’d like to walk you through some Rx saving strategies you might not have considered.

Switch to a Transparent PBM

Changing horses is hard, complex, and time-consuming. That’s why so many employers don’t want to do it. But sometimes it’s your only option to impact your overall prescription spending.

Some Pharmacy Benefit Managers (PBMs) offer more transparency than others; these carriers make it easy on employers and consultants when it comes to negotiations, plan adjustments, and more. While you might think they’re a myth, transparent PBMs are out there, and they’ll help you save wasted dollars on prescription benefits.

What does transparency really mean?

  • They share data freely—you’ll have access to the info you need to watch trends, calculate costs, and predict future spend.
  • You’re able to fully align on goals and a comprehensive formulary management strategy.
  • You have the ability to audit their coverage and your formulary at any time.
  • Customizing your plan is expected, not seen as a hassle or an “extra.”

Demand 100% pass through

What is 100% pass through? Essentially, PBMs get certain incentives and rebates from drug manufacturers. In exchange for keeping drugs on their clients’ formularies, the PBM receives a rebate check. While some PBMs will “pass through” these payments to employers, others will not.

Imagine if you paid what the PBM pays, and you get what the PBM gets from the pharmaceutical companies. This is something all self-insured employers should demand from their PBM. If they’re willing to follow this best practice, they’ll also be willing to help you reduce costs and closely manage your formulary. While you’re more likely to get 100% pass through by switching to a transparent PBM, you can make this part of your negotiations with your current vendor.

Therapeutic Drug Substitution

Therapeutic drug substitution is controversial with patients, but if it’s done well, it can help both members and employers save on their prescription costs. Essentially, this is the process of identifying and substituting a lower-cost drug for a more expensive drug. Some less expensive prescriptions will be generics, others will be packaged differently, and still others may simply be two pills instead of one combination tablet.

Clinical staff/resources are crucial to using this strategy. Working with them will help you consider patient health and outcomes before adjusting your formulary. Their expertise will help you ensure that members get the drugs they need and minimize disruption to their care.

Continual formulary management

You know about formulary management; this strategy is no secret. But how often does your PBM allow you to make formulary adjustments? Is it a time-consuming negotiation that requires a lot of resources on your end, both benefits staff and a consultant? It shouldn’t be.

Continually adjusting your formulary should be a requirement during the RFP process when you’re selecting a PBM. You shouldn’t be boxed into once-a-year changes. Along with data, this will allow you to monitor trends, contain costs, and make adjustments or conduct an audit on your terms and your schedule.

Looking for more insight into your Rx data? Artemis can help. Get in touch for a demo or a chat with our team.

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