Lowest Net, Net Programs
Utilize a pricing platform that assures you, as plan sponsor, that you are purchasing prescription drugs at the lowest price point in the market.
Pharmacy Benefit Manager (PBM) contracts can be complex and the impact of the provisions on pharmacy costs and benefit design are not always easily understood. We can offer our clients an independent review of contractually guaranteed programs, performance measures, and benefit design flexibility that allow you to make needed refinements as well as position you better for negotiations with your PBM vendors. Our consulting services around pharmacy programs will lead to lower costs. RX Formulary Review will assess formulary effectiveness and recommend changes to avoid wasteful spend with a special focus on drug classes and products that may promote inefficient utilization trends. Program and Contract Review can establish safeguards around abuses that can occur within the industry that lead to higher costs.
Physicians have historically written prescriptions based on the statistical probability of success for a given patient. However, the effectiveness of any prescription drug will vary across different individuals due to factors such as unique gene structure, metabolism, and absorption. Enter pharmacogenomics, which is the science of testing an individual’s unique gene structure and using the information to determine effective medication therapies.
Current prescribing patterns can work for many but create inefficiencies and potential safety issues for patients with genetic profiles that differ from the “norm.” This has led to rising research in the field of pharmacogenomics. In fact, the Food and Drug Administration (FDA) has begun including pharmacogenomic details on over 150 prescriptions with the goal of providing greater transparency to individuals with various gene structures.
Imagine the possibilities – what if oncologists were able to determine whether a specific cancer therapy medication would yield positive results before writing the prescription? That could save valuable time for the patient and substantial costs. Historically, patients were prescribed medications with the hope it would provide “typical” results. Not everyone is typical, which is why side effect labels exist.
The federal government through CMS’s Retiree Drug Subsidy program allows qualified plan sponsors the ability to receive a direct cash subsidy on 28% of the eligible drug spend on their Medicare retiree population. Our sister company, RDS Services, LLC has developed proprietary software to synchronize multiple data sets to maximize this subsidy. If you have not taken advantage of this program or may have moved your plans to Medicare Advantage Prescription Drug (MAPD), do not fret. The CMS regulations allow us to go back four years, the ultimate “do over”, so that you can receive additional subsidy under our maximization process at no risk to you.
Pharmacy spend now represents 25% to 30% of the overall expense on healthcare and is expected to increase at a rate of 5% to 10% each year for the foreseeable future. Specialty drugs account for around 33% of overall drug spend and is expected to increase to 50% by 2020 even though only 3% to 5% of your employees and retirees use specialty drugs.
Manquen Vance along with our sister company RDS Services, LLC have introduced a NEW SUBSIDY program that guarantees a “direct” subsidy equal to 15% on all your affected pharmaceuticals’.
LEARN MORE HOW YOU CAN ACCESS THIS SIGNIFICANT SAVINGS ON THE PORTION OF YOUR HEALTHCARE COSTS INCREASING THE MOST BY CALL US 248-878-2100 TODAY!