Pharmacy Consulting

Pharmacy Consulting and Contract Reviews

Prescription drug spending now makes up as much as 25-30% of your total company’s healthcare cost.  ExudeRx, a pharmacy consulting practice with a team of Certified Pharmacy Benefit Specialists (CPBS) are able to deconstruct your prescription program, and create greater transparency and more advantageous contracts, allowing for an immediate reduction of cost (many time upwards of 30%).  Best of all – there is no change to benefit or plan design.  As one of only 600 Certified Pharmacy Benefit Specialists in the country, ExudeRx can help reduce the cost of this unnecessarily expensive employee benefit.

What is Pharmacy Consulting?

Pharmacy benefit consulting is a specialized service that provides expert advice and guidance to organizations on managing their pharmacy benefits programs. Pharmacy benefits are a significant component of an organization’s overall employee benefits package, and pharmacy benefit consulting helps organizations to maximize the value of their pharmacy benefits while minimizing costs.

Pharmacy consulting services typically involves a comprehensive review of an organization’s pharmacy benefits program, including the plan design, prescription drug formulary, pricing, and utilization management strategies. The pharmacy benefit consultant works with the organization to assess its pharmacy benefits needs and goals, and develops a customized pharmacy benefits program that meets those needs and goals.

Here are some of the key functions of a pharmacy benefit consultant:

1. Assessing pharmacy benefit needs: Pharmacy consulting services help organizations assess their pharmacy benefit needs and goals. This may include reviewing utilization data, analyzing prescription drug claims, and evaluating employee feedback on their current pharmacy benefits program.
2. Developing a customized pharmacy benefits program: Based on the needs assessment, the pharmacy benefit consultant develops a customized pharmacy benefits program that meets the organization’s goals and budget. The program may include strategies such as formulary management, utilization management, and prescription drug pricing.
3. Implementing the pharmacy benefits program: The pharmacy benefit consultant assists the organization in implementing the new pharmacy benefits program. This may include working with the organization’s HR team to communicate the changes to employees, setting up new contracts with pharmacy benefit managers, and providing training to employees on how to use the new benefits program.
4. Monitoring pharmacy benefit program performance: Once the new pharmacy benefits program is implemented, the pharmacy benefit consultant monitors its performance to ensure that it is meeting the organization’s goals. This may involve analyzing utilization data, reviewing prescription drug claims, and providing recommendations for adjustments or improvements.
5. Staying up-to-date on pharmacy benefit trends and regulations: Pharmacy benefit consultants stay up-to-date on changes in regulations and trends in pharmacy benefits. This knowledge allows them to provide expert advice to organizations on how to manage their pharmacy benefits programs to ensure compliance with regulatory requirements and take advantage of the latest trends in the industry.

The Benefits of Pharmacy Consulting

There are several potential benefits to carving out your prescription drug benefit. Here are a few of the most significant advantages:

1. Cost savings: One of the most significant benefits of carving out your prescription drug benefit is cost savings. PBMs negotiate directly with drug manufacturers and pharmacies on behalf of the organization to obtain the best prices for prescription drugs. Because PBMs work with multiple clients, they can leverage their buying power to negotiate better prices and discounts than an individual organization could obtain on its own.
2. Increased transparency: By separating your pharmacy benefits program from your comprehensive benefits plan, you gain more transparency into the costs and pricing of your prescription drugs. PBMs provide detailed reports on the costs of each drug and the discounts negotiated with pharmacies, allowing you to better understand the cost drivers of your pharmacy benefits program.
3. Flexibility: Carving out your prescription drug benefit provides more flexibility in plan design. Instead of being tied to the benefits and plan design of a comprehensive benefits plan, you can tailor your pharmacy benefits program to meet the specific needs of your organization and employees.
4. Expertise: PBMs have expertise in managing prescription drug programs and can provide guidance and advice on best practices for managing your program. They have access to a wide range of data and resources to help you optimize your pharmacy benefits program, including information on drug formularies, utilization management strategies, and clinical guidelines.
5. Improved member experience: PBMs provide tools and resources to help members manage their prescription drug benefits. These tools can include mobile apps, online portals, and customer service support. By providing better tools and resources, PBMs can help improve the member experience and increase satisfaction with the pharmacy benefits program.

In summary, carving out your prescription drug benefit from your employee benefits package can provide several benefits, including cost savings, increased transparency, flexibility, expertise, and improved member experience. Before making any changes to your pharmacy benefits program, it’s essential to work with a trusted advisor, such as a benefits consultant or PBM, to assess your needs and goals and develop a customized plan that meets your organization’s needs.