Pharmacy Cost Control
Prescription drug costs are accelerating at a faster pace than medical care. Pharmacy spend, driven by specialty drugs developed to treat complex and chronic diseases, is expected to exceed 50% of combined medical and pharmacy spend in coming years. In any evaluation of benefit plan costs, it is important to focus attention on your pharmacy benefit manager (PBM) as well as member utilization patterns.
Our team will evaluate, recommend and implement a program designed to affect how members utilize the prescription feature of the medical plan. As part of our pharmacy consulting, we will
- review current PBM contract terms,
- secure bids from available PBMs for the best discounts and potential manufacturing rebates,
- examine top-cost drug categories, utilizers and evaluate saving opportunities,
- evaluate prior authorizations and cost-containment programs, and
- interface with the TPA to ensure the pharmacy program is properly aligned with the medical plan and more.