Importance of Prescription Drug Plan Modeling for Self-Funded Employers

For self-funded employers, changing Pharmacy Benefit Managers (PBMs) is an incredibly tough decision because it's difficult to know how changes will impact the overall budget. However, sometimes making a PBM change is necessary to better manage costs, particularly when cost drivers could be reined in by adjusting which PBM is managing your benefit and how proactive ongoing clinical oversight actually is. And while trying to lower prescription drug costs, employers must also consider how plan design changes will affect their employees. The best solution to addressing the cost concern while still providing a quality benefits plan is to engage in plan modeling.


Provides a Preview of Potential Cost Saving Solutions
Prescription plan modeling makes it possible for employers to see how claims would have been paid differently with improved pricing, return of rebate revenue, with current plan designs in place, along with our Clinical Pharmacist’s plan design recommendations. This can be done by looking at the historical claims data and conducting claims analysis to identify problem areas in their current health plans. This analysis can show you potential solutions for lowering prescription plan costs - for example, if the analysis were to show that brand drug costs were disproportionately high, an employer might consider raising the copay for brand drugs or looking at generic alternatives.

Allows Employers to Test-Drive Changes
The more models employers run, the greater the potential for cost savings. Even if you are just thinking about making plan design adjustments because you suspect it would drive better claims results, the use of modeling can help you test-drive those changes before implementing them. The results of the modeling will help you see the outcome of suggested changes to your current benefit structure, and allow you to see in advance if the change would be a cost effective choice. For self-funded employers who are trying to limit expenses, prescription drug plan modeling is essential.

Employers Can Balance Value and Cost
With the data provided for a claims and benefit savings analysis, an employer can make educated, strategic decisions that balance its financial benefit with its employees’ needs. By viewing upfront how much money new strategies have the potential to save over time, employers eliminate the risk of benefits missteps, like implementing drastic changes to popular benefits offerings. This allows employers to truly balance the value and cost of their pharmacy benefit plan. For most employers, identifying and managing even just a fraction of their costs can generate significant savings.

Talk to Synergy Pharmacy Benefit Consultants About a FREE Claims Analysis!
Our services deliver state-of-the-art auditing technology to provide immediate feedback on PBM performance, including contract compliance and opportunity analysis for cost management.  With pricing in place, Synergy ensures the best possible outcomes through high-cost management and contract audits. We are uniquely positioned to manage the entire spectrum of PBM services – from selection to annual audits – to ensure employers receive benefit options and services typically reserved for exclusive entities. We offer affordable benefit management solutions for self-funded employers that can help save big! Let us provide a FREE no-obligation claims analysis to see if we can help lower your prescription drug costs!

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

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