In order to accurately tailor the pharmacy benefit plan design and deploy customized clinical strategies, benefit advisors should work with hospitals to help them understand the exact utilization of the plan's membership. This includes:

Working with an independent benefits partner that understands the member population and uses hospital claims data to identify risk areas and how those are driving pharmacy costs
Designing a plan that promotes hospital-owned fulfillment channels (i.e., the hospital's on-site pharmacy) first, with frequent plan design evaluations
Evaluating high-cost brands and specialty medications members are taking, and whether there are cheaper, generic options available, when appropriate
Accessing Manufacturer Copay Assistance Programs (MCAP), when available, and 340B Drug Pricing Discounts, if eligible

Hospitals are looking for creative ways to cut the cost of benefits without disrupting their already burnt-out staff. What are some of the best strategies they can employ, and are there any they should avoid?

There are a few creative ways to help hospitals cut the cost of benefits without disrupting staff. The first way is to carve out pharmacy benefits, if this is not already done. Allowing the pharmacy benefit to remain bundled, or "carved in" with a medical carrier means hospitals are going to pay more than is necessary for the pharmacy benefit. By self-funding and carving out their pharmacy benefits, hospitals gain full control over selecting a pharmacy benefits partner, network, and stop-loss carrier that align with the hospital's service needs and savings objectives. In all, carved-out arrangements, allow hospitals to:

Negotiate a more transparent contract with competitive rates and rebates
Access the most clinically appropriate medications at the lowest net cost
Provide employees with service they will appreciate

It's important to note that success in this effort depends on selecting a partner that is uniquely equipped to secure a more transparent contract with competitive rates and rebates, provide clinical oversight focused on drug appropriateness and cost, and deliver on a service experience that exceeds the employees' expectations.

Instant Insights /

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