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TAKE FIVE – Investigate: A Cliff Note Series on Pharmacy Benefit Management

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Last week, I covered Part One of my TAKE FIVE series, which focused on educating you on the importance of staying on top of your Rx benefits. This week, I'll continue this series by sharing with you my thoughts on how to “investigate” your pharmacy benefit plans. So, without further ado, let's take a look at what you should be looking for:

Week Two - TAKE FIVE to Investigate: First of all, it's important to understand what I mean when I use the term 'investigate'. So, let's take a look at the definition: "carry out a systematic or formal inquiry to discover and examine the facts of (an incident, allegation, etc.) so as to establish the truth." (Synonyms - inquire into, look into, probe, explore, scrutinize.) This is an essential part of effectively managing your pharmacy benefits, and shouldn't be disregarded.

Components of Your Pharmacy Benefit Plan
The world of the pharmacy ecosystem is complex and constructing a pharmacy benefit plan suitable for…

TAKE FIVE – Educate: A Cliff Note Series on Pharmacy Benefit Management

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Over the next five weeks, I will be sharing my TAKE FIVE series. TAKE FIVE breaks down into five simple parts of recommended steps to evaluating your pharmacy benefits. Yes, it can seem overwhelming. Yes, it is complex. Yes, there is finger pointing on the causes for rising Rx drug costs.  Yes, you may see Rx proposals that would appear to be a great deal, only to discover (too late), that the “new deal” is more costly. Yes, the world of PBM seems murky at times. My TAKE FIVE series is intended to offer clarity on the Pharmacy Benefit Management evaluation topic.


We will break down this complex topic into five components:

EducateInvestigateValidateFacilitateInvigorate
Week One – TAKE FIVE to Educate:
Stay Educated About Your Rx Benefits
Pharmacy benefits can be confusing. Between specialty drugs, trends driven by more than cost and utilization, and pricing factors, there are many moving parts and considerations. As an employer who's got your hands full juggling other aspects of your …

What's Affecting Rx Drug Costs and Tips to Control It

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Employers, are high prescription drug costs making your blood pressure rise? Do you know that the pharmacy benefit is THE most used benefit? In fact, its used 3 times more than your medical plan! Prescription drug spending growth is at historically high levels – which makes it tough to contain Rx costs and maintain or improve the quality of care for your employees.


What's Affecting Cost?
With the pharmacy drug landscape continually changing, a number of factors are affecting drug costs:
Unbridled manufacturer cost increasesA specialty drug pipeline filled with expensive and much needed biologicsInefficiencies and redundancies in the FDA drug approval process for generic drugs, slowing down more cost effective drugs from being released.Employers running out of money to fund benefits and cost-shift to employeesSick employees going bankrupt or trading on the Dark Web to get their medications Twenty-seven percent of employers are using a high deductible plan to help control both pharmac…