You need a pharmacy strategy to ensure all aspects of your pharmacy benefit — from pricing terms and contracts to clinical programs and drug utilization — are aligned to stretch your pharmacy dollar. How do you get there?
At Holmes Murphy, our experts are equipped to help you control pharmacy spend as it continues to grow at record paces. In the past, employers have traditionally depended on their insurance brokers to unite the carrier, third-party administrator, and Pharmacy Benefits Manager (PBM) to provide a solution for handling their pharmacy expenses. While this approach might have been effective previously, it’s not sustainable for the future.
What You May Not Know About Pharmacy Benefit Managers
A PBM must find ways to extract additional revenue from existing customers to grow, meaning they could overcharge their existing customers to expand their business or profit margins. This is the problem with the structure of most PBM relationships today. Financial gain and not clinical effectiveness drive formulary placement.
This lack of transparency and complexity in the pharmaceutical sector is concerning for employers. That’s why having a dedicated PBM expert who understands the industry’s nuances is crucial for protecting plan sponsor benefit spend, and that’s where our expertise lies. At Holmes Murphy, we bring the right partners to the table to deliver consistent, high-quality consulting services throughout the year, ensuring peace of mind while presenting cost-effective spending alternatives.
We focus on areas, including:
- High-cost infusion products administered under the medical benefit
- New-to-therapy treatment options
- Manufacturer co-pay assistance programs
- Definitions
- Audit language
- Claims inclusion in performance metrics
- Exclusivity on mail order and specialty drugs
Our goal is to help you understand your current pharmacy contract, identify ways to reduce cost, and ensure the contract is the right fit for your organization.
