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Employers - Are You Paying More for Your Rx Program than Expected?

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Employers, you could be paying more for your prescription drug program than you ever expected, and getting less and less for your money. You deserve the best for your investment, including topnotch service, reporting, claims analysis, and the deep discounts typically offered only to very large entities. So, how can you ensure you're getting the same service as large corporations for a price that you can afford? The answer is simple: Hire a prescription solutions expert to work with your broker or consultant to provide ongoing claims analysis, ensuring you are getting the most for your money!


Don't Pay More For Your Rx Plan than Required
A Pharmacy benefit expert, working with your broker or consultant, can ensure that there is no waste taking place in prescription drug use and that employers are not paying more for their prescription drug plan than required. How we accomplish this is by conducting ongoing daily reviews of all drug claims over $500, looking for errors, opport…

The Diabetes Dilemma - A Growing Epidemic

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According to the Centers of Disease Control, diabetes is the 7th leading cause of death in the United States. It is a progressive disease that can cause many serious complications. Chronically elevated blood sugar levels can wreak havoc on your body. Untreated, diabetes can cause several life altering -and even life threatening - conditions, such as heart disease, heart attacks and stroke, kidney failure and blindness. More recent studies have even shown a possible connection between diabetes and Alzheimers. So how does this all play a role in impacting self-funded employers' health care costs? Let's find out:


Non-Adherence is a Problem
Diabetes affects nearly 30 million Americans. Unfortunately, there is not a one size fits all treatment solution. Every person requires personalized attention and treatment. Co-morbidities and complications make diabetes a difficult, costly challenge that can only be controlled with a high standard of clinical care. 87% of those with diabetes ha…

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

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Over the past four weeks we have discussed finding a trusted advisor to educate you on the current pharmacy benefit landscape, investigating your benefit plan designs, pulling your claims data for analysis, validating for opportunities to improve and tighten up your contracts - its pricing and clinical programs - to eliminate waste, and create a roadmap to better pharmacy management. Now let's focus on how all of this adds up to reaping the benefits of your new and improved contract, clinical and medication assistance programs and daily oversight!
WEEK 5 - TAKE FIVE to Invigorate This is where you as a self-funded employer get to reap the rewards of taking the reins, kicking the tires, and engaging with knowledgeable PBM professionals to look at alternatives. This is where you get to be served by a trusted advisor who has your best interest in mind, is highly experienced, knowledgeable, and laser focused on YOU, YOUR interests and YOUR goals. At this point, you have engaged with…

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

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Over the past few weeks we have discussed finding a trusted advisor to educate you on the current pharmacy benefit landscape, investigating your benefit plan designs and pulling your claims data for analysis, validating with claims data opportunities to improving and tightening up your contracts, its pricing and clinical programs to eliminate waste. Now it is time to DO SOMETHING WITH THE RESULTS!

WEEK 4 - TAKE FIVE to FacilitateFacilitate Your Strategy
Now it is time to create the road map to better pharmacy benefit management. For the Human Resources and Benefits Departments, this will require engagement with your employees. Tweaking copays, implementing clinical programs to eliminate waste and improve adherence for chronic conditions require guidance based on data. Your Pharmacist and Account Manager should be making recommendations on which programs are available, and their possible savings. Helping your employee or their family member deal with a chronic condition cannot be succes…

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

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Over the last two weeks, I covered different facets of the pharmaceutical management industry and how it can affect your pharmacy benefit contract in my TAKE FIVE series. So far, I've gone over "Educate" and "Investigate" of this 5 Part series. This week, I'll continue this series by sharing with you my thoughts on how to “Validate” your pharmacy benefit plans. So, let's dive right in:


WEEK 3 - TAKE FIVE to Validate
Every two weeks in the U.S., tens of billions of dollars in pharmacy benefit claims are paid by plan sponsors without review! This means that mistakes due to system problems, coding errors, complexity of PBM contracts and ever-changing pricing discounts are leading to costly errors that sponsors and self-funded employers aren't catching. So, ask yourself this question: What good does it do to spend lots of time and money on trying to negotiate the best PBM contract if you're not taking the time - or working with a partner - to validat…

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 …