Every hospital and health system in the country has a robust workforce – typically between 600 and 30,000 doctors, nurses, pharmacists, and support staff – for whom it must provide medical and prescription insurance. When you factor in the additional coverage of those employees’ beneficiaries and dependents, some health systems end up providing insurance for as many as 100,000 people.
In recent years, rising drugs prices and several other factors have caused pharmacy benefit costs to increase, leaving many hospitals and health systems in search of a solution to optimize their employee health plan prescription benefit design.
Here is a closer look at the importance of pharmacy benefit management (PBM) program design and opportunities, the relationship between health systems and brokers/outside PBMs, and the critical role Visante plays in helping optimize employee health plan prescription benefit outcomes for organizations across the country.
The Importance of Employee Health Plan PBM Design and Strong Performance
The majority of hospitals in the U.S. are self-insured – including the risk involved with the high-cost employee retail and specialty pharmacy benefit – and are thus incentivized to manage insurance plans to keep costs down. But unlike most employers, health systems are in a unique position within the employee pharmacy benefit marketplace because they can maximize total plan savings by leveraging their own internal pharmacy resources.
This is important because proper coordination between a health system’s plan and pharmacy can almost always result in improved employee health and organizational financial outcomes – not to mention employee convenience and savings. However, many of these plans are managed with support from outside brokers and their partner PBMs that can create a significant hurdle within the optimization process.
Brokers and Outside PBMs
Most PBM contracts seek to retain as much revenue as possible within the PBM (and broker) ecosystem. As a result, PBM contracts are typically built without consideration to the health system’s many inherent advantages – especially when the health system has internal pharmacy expertise as well as an internal retail pharmacy option available to serve employees.
Visante can play a critical role in helping hospitals and health systems craft well-designed benefits programs that offer more to team members at a reduced cost, while also making the most of their internal pharmacy program to drive significant savings and employee wellbeing.
Visante’s Approach to Employee Pharmacy Benefit Design
Visante takes a unique approach to improving pharmacy benefit design and prescription access for our clients, typically leveraging five steps in doing so:
- Review and reconciliation of PBM contract(s) and current plan design to understand structure, performance, and hurdles to success.
- Analysis of pharmacy claims data to establish a plan performance baseline, which often identifies savings opportunities from initiatives allowed by the current PBM contract and initiatives that may be negotiated into future contracts.
- Creation of a customized PBM assessment report that provides an unbiased perspective on current PBM performance and proposed strategies and recommendations for next steps – including anticipated savings to be achieved upon implementation.
- Determination of strategies best-suited to help the client move forward to maximize savings, including support of the client in PBM negotiation and/or RFP support if requested.
- Strengthening of partnership between internal pharmacy and HR leaders to ensure strong plan performance and savings are maintained on a long-term basis.
There is always an opportunity to redesign benefits programs, perform routine performance reviews, and implement mitigation strategies to help hospitals leverage their unique ability to lower drug expenses and drive savings. Visante does not seek to replace broker or PBM services, but rather to provide contemporary, unbiased insight into PBM performance, as well as a roadmap toward unique financial savings and future entrepreneurial growth.
Contact us today to learn more about optimizing your own employee pharmacy benefit program.
Join Jim Jorgenson, MS, RPh, FASHP, CEO, as he discusses PBM contracts and how Visante can help health systems understand and craft strategies that optimize their investment for their employees.