Are your pharmacy costs and utilization continuing to increase? Are pharmacy related services more than 10 – 15% of your overall PMPM health care costs? Are you concerned your PBM might not be producing the value you anticipated? Are your pharmacy benefit plans out of date?
Pharmacy costs are rising at least 15% to 18% per year, outpacing all other benefits. These excessive increases are negatively impacting health plan profitability and are a major cause of high premium increases. PBM contracts are complex, have significant variation with a vast portion of the health plan benefit based on rebate agreements, not reduced utilization and costs. PBMs are not providing data in a timely fashion for most plans to react. Plan sponsors, health plans and medical managers need an improved solution to more effectively manage prescription drug benefits and stay ahead of the market.
How can AHP help?
AHP consultants have developed and assembled a consulting solution for our health plan clients. We complete the following:
- Analyze current data including contracts, utilization, costs, discounts, rebates, dispensing fees and trend rates
- Analyze pharmacy benefit packages including benefit maximums, out of pocket maximums, injectable drug coverage, OTC drugs, member benefits, formulary scope, and mail order usage
- Compare to current best practice and proprietary benchmarks
- Present analysis and recommended changes to management
- Complete projected ROI based on recommended changes
- Assist in the implementation of changes as needed
- Provide optional physician risk modeling and web based consumer behavior modification programs
Why Axene Health Partners?
AHP professionals have been leading edge consultants within the health care industry. Our services are based on first hand knowledge of industry practice, knowledge of PBM contracts and revenue models (including rebates and pass throughs). We have developed and utilize an ideal practices model showing what drug use and costs should be for populations based on Symmetry’s ETG model. We utilize a multi-disciplinary team of consultants to meet our client’s diverse needs.
For more information, contact us at info@axenehp.com.