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

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:

  1. Educate
  2. Investigate
  3. Validate
  4. Facilitate
  5. Invigorate

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 business, Synergy Pharmacy Benefit Consultants knows that trying to understand your prescription benefits may be the last thing on your mind. That's why we feel it's important to educate you on why you should pay attention to your Rx benefits and strive to get it right the first time.

Rx Benefits are the Most Important Benefit to 'Get Right'
Prescription drug benefits are the most used benefit, and the benefit that is most changing before our very eyes. During the past 3 years, leading PBMs have excluded over 340 drugs, and some include generic drugs. Part of the rationale is to reduce costs and negotiate deeper discounts. But other drivers are increased rebate revenue for preferred brand drugs (in some instances that cost more vs their generic counterparts), unnecessary waste in spending costing tens of thousands of dollars, use of designer generics, and hyperinflation just to name a few. With the ever increasing costs of specialty and non-specialty drugs, it's essential to have a plan of action to control your out-of-pocket expense – minimizing spending on low value drugs and maximizing use of high value drugs.

Let's Put the Focus Back on YOUR Needs
If you've ever felt like your pharmacy benefit manager isn't hearing your needs or that they have their own motives, you're not alone. It's a pretty common problem that many employers, brokers and consultants face on a daily basis when dealing with pharmacy benefit management solutions. Fortunately, not all of us are created equally. You should feel at ease that your PBM is doing what needs to be done to ensure your employees are able to get a prescription at the pharmacy and they should be responsive when things don’t go as planned. After all, these are YOUR employees. YOUR business. So it’s my job to make sure I support YOU in every way I can.

Trust a Knowledgeable, Experienced, and Laser-Focused Advisor
In the world of business and pharmaceutical management, there's always room to keep improving and innovating. I can help you achieve some of your Rx benefit goals by helping you to administer your pharmacy benefit program that isn't a one-size-fits-all model. Carving-out pharmacy benefits provides advantages like flexible plan design, increased transparency, implementation credits, greater access to rebates, and the right to audit. It also allows for more robust reporting, continual contract auditing, and clinical and account management plus greater insight into how the pharmacy portion of the plan is performing. Your business isn't like every other business out there, and you need prescription benefits that meet your employees’ wants and needs, while providing you with the security of cost control and effective utilization. I can help you obtain that!

Pharmacy benefits are complicated, but services are available to help employers understand the complex prescription drug ecosystem. These services give employers and brokers the confidence that they can secure competitively priced PBM contracts, and maintain affordable, high-quality prescription drug coverage for their employees. So, for employers with mid year medical and pharmacy contracts expiring who are troubled by benefit costs and increasing trends, why not schedule a 30 minute conversation with me to discuss your concerns and needs!

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Affordable Best-in-Class 

Pharmacy Benefit Management Solutions

Synergy Pharmacy Benefit Consultants, LLC
2111 Bagnell Dam Blvd #37
Lake Ozark, MO 65049


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