Where people are born, how they are raised, where they go to school … all of these factors have an impact on a person’s health.
Pharmacy benefits are one of the most important employee health benefits that a company can offer for recruitment and retention. But healthcare is complicated. Prescription drugs and pharmacy benefits managers (PBMs) are at the center of a world populated by pharmacies, prescribers, health plans, brokers, consultants.
When you’re looking for a PBM contract, you need to understand what they do and how it will affect your bottom line. It’s a journey where you need to speak to specialized languages of pharmaceuticals, medical care, health insurance, and government regulations.
PharmAvail understands the different needs of stakeholders – employers, providers and members. PBMs are at the center of a world populated by those stakeholders and others, including health plans, third-party administrators, brokers, consultants. We can be your guide and translator.
Employers need to balance the healthcare needs of plan members and the high cost so many medications. Providers want to deliver care and make a living. Members want to get prescriptions filled at the lowest possible out-of-pocket cost. PharmAvail is a PBM that believes stakeholders should be able to make informed decisions through collaboration.
We will help you understand what you need to know about PBMs and their services, and what questions you should ask when choosing a PBM.
Here are some of the discussions you should have:
Consolidation in the PBM market means that it is dominated by three mega-PBMs, who may have a take-it-or-leave-it attitude, particularly for small employers.
Some PBMs are more concerned about their relationship with pharmaceutical manufacturers than with their clients because they benefit financially through rebates. This can influence whether a brand drug is placed on the formulary.
Pharmacy networks may be broad, national networks to provide maximum access for members. But a smaller “narrow” network may be just as good for a regional or smaller business.
Utilization management is a large piece of your benefit design to contain costs. Knowing and understanding your benefit options will help you in the long term.
Most PBMs should offer a mail and/or home delivery option for the benefit plan.
Specialty drugs account for half or more of drug spend and accounts for 1-2% of claims. They are also 10x more expensive than non-specialty drugs.
For more information or a free claims analysis, contact us today at firstname.lastname@example.org.