What's the bottom line? For many employers, that is the singlebiggest question they have regarding pharmacy benefit plans. It's not always an easy questionto answer. Analysts note that costs are moderating, yet foremployers and plan sponsors, pharmacy costs continue to take a hugechunk out of their benefit dollars.

In addition to price within a pharmacy benefit plan, valueencompasses:

• Quality (defined by outcomes and employee quality of life)
• Price (how much will this cost?)
• Member satisfaction
• Value-added programs (e.g., care management for patients withdiseases such as cancer or multiple sclerosis)
• Innovative approaches to benefit design
• Trust and faith (exemplified by a PBM's willingness to provideappropriate disclosure on pricing and practices)

Many factors go into what employers pay for their pharmacybenefit program — not just the price of the prescriptiondrugs. For example, rebates, discounts, administrative fees andother services a pharmacy benefit plan provides, such as mailservice, disease management programs, etc. also contribute to cost- and to value.

The cost of a pharmacy benefit plan’s services should not bemeasured by how much it charges for prescription drugs, or how muchthey will charge for filling prescriptions (which are often the topitems employers look at). Costs should be measured by total claimsand fees (e.g., administrative, network, etc.), minus rebates.Because roughly 97 percent of this benefit’s net cost is incurredclaims (how many prescriptions are filled; what those prescriptionscost), the best way to lower costs is to manage claims throughstrong clinical programs and effective utilization management.Pharmacy benefit programs that provide those capabilitiesultimately will provide the best value.

In short, employers should be asking about clinical programs,utilization management and programs that provide value-addedservices. Strong clinically focused pharmacy programs willoffer:

• Responsive, proactive client and customer service
• Care management to help employees with serious illnesses
• Targeted disease management programs that include educationaimed at the employees' specific needs
• Innovative benefit designs to encourage generic utilization andprovide affordable coverage for high-cost specialty pharmacy (alsoknown as injectable or biotech) drugs
• Mail service, to help employees save more money

To avoid focusing on cost alone, here are some questionsemployers can ask that will help to ensure they are getting themaximum value from their pharmacy programs:

• What types of clinical programs does the pharmacyprogramoffer?
• Does the pharmacy programhave a track record within clinicalprograms to show outcomes and return on investment? What is thepharmacy program’s experience in maximizing the use ofgenerics?
• Is the pharmacy program willing to be audited annually?
• Can the pharmacy program demonstrate they are providing theplan sponsor appropriate disclosure?

The primary goal of any pharmacy plan should not be simply tolower cost. An emphasis on cost alone can lead to higher medicalcosts, poor outcomes and a pharmacy benefit that provides littlereal value. Only by focusing on the complete array of componentsthat comprise an effective pharmacy benefit program, can employersensure they secure the best cost and the best value.