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Managing Pharmacy Benefit Costs: The Basics

Controlling pharmacy benefit costs There are plenty of techniques to control pharmacy benefit cost. However, it is critical to understand that while PBMs or pharmacy benefit managers can deliver services and programs to help manage prescription drugs, it is ultimately the plan sponsor’s responsibility to create the plan coverage with help from experienced consultants and direct the PBM when implementing the program.

Basically, the following are some common ways used to control pharmacy benefit cost, as detailed by

  • Evaluate the pharmacy benefit plan to see if it fits the overall healthcare program. Know that since flat-dollar co-payments haven’t increased in recent years, majority of plans are actually subsidizing pharmacy benefit costs up to 95%.
  • Assess what areas require further evaluation and management. Normally, the most regularly dispensed prescription medicines are for depression and ulcer. With this, sponsors have to ensure that there’s a program to aid employees using these medications properly.
  • Utilize these pharmacy management techniques and tools:
    • Aim for the smallest size pharmacy network without compromising easy access. Likewise, consider incentive programs that offer higher reimbursements for increased formulary compliance and generic substitution to reduce cost trends.
    • Consider creating a plan that encourages employees to lean more towards generics. For example, they’ll be required to pay the difference between the generic drug cost and the branded drug if branded drugs are required by the employee.
    • Decide on a formulary developed to promote clinical therapeutic and cost-effective medications, along with a rebate program that will most benefit plan sponsors.
    • Offer retail POS or mail service prescriptions, instead of being a requirement, and allow the co-payment’s daily supply to be equal regardless whether it’s through mail service or retail pharmacies.
    • Implement utilization management targeting users considered as high-cost and mediating with both employees and their physicians to ensure the best results.
  • Explain cost trends to employees so that they can make more informed decisions.
  • Anticipate the potential impact of new medications and develop procedures and policies for them prior to their release.

Pharmacy management has several ways to control the costs of drugs in the market. By following these guidelines, you can be assured of medicines that are well worth the price.

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