Health systems are in a unique position within the employee pharmacy benefit marketplace compared to most other employer groups. They have the power to maximize total plan savings simply by taking advantage of internal pharmacy resources that are not found within typical employee plans.
Health system plans can escape their Pharmacy Benefit Manager’s (PBM’s) retail network demands by negotiating with its internal pharmacy to dispense drugs on a custom at-cost financial arrangement that provides savings to the plan and ensures the pharmacy is kept whole.
Likewise, pharmacy employees can be significant assets to a health system’s PBM negotiations, as well as with overall management strategy and ongoing decision-making processes. Greater coordination between a health system’s plan and pharmacy will almost always result in greater health and financial outcomes, as well as employee convenience. The triple aim outcome will always be: “better care – better service – better financial performance.”
The biggest hurdle to a health system achieving these benefits is a PBM contract that seeks to retain as much revenue within the PBM ecosystem as possible. As a result, typical PBM contracts are built without consideration of the health system’s advantages.
For example, when negotiating a custom pharmacy financial arrangement or revising formulary placement, PBM contracts may attempt to take contractual credit for the newly reduced costs or replace lost revenue with excessive fees elsewhere. 340B utilization further complicates these negotiations that require knowledgeable industry nuance to settle.
Visante offers the insights of its PBM consultants specialized in health system employer plans to assess plan performance and ensure that each of our clients receives maximum value for the organization and its employees.