Are You Getting the Right Transparency?

Are You Getting the Right Transparency?

At Gateway Health Partners, we’re asked all the time what our key differentiator is as an organization. It’s actually two things that rely on one another: transparency and predictability.

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We consider both of these to be hallmarks of good rebate and formulary management—but, unfortunately, they can be more difficult to find than they should be. That’s because too often companies rely on broad contract modeling and guarantee promises that put “best case scenarios” on display to secure a company’s business.

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AN APPROACH PAST ITS PRIME

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Many of us have sat in a boardroom presentation or teleconference pitch and been wowed by the numbers being projected. These rebate performance promises are often enough to get a contract signed, sealed … but not quite delivered. Very quickly, reality sets in.

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We’re told how key factors were excluded from that initial pitch which now needs to be considered. And the partner mentions how our business is unique and won’t always match up to what the market is doing. From the minute the ink is dry the adjustments can start happening.

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These are some of the factors that we hear may be left out of business pitch meetings and initial contracts:

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  • Excluded limited distribution drugs (LDD)
  • Broader exclusion of OTC
  • Excluded biosimilars
  • Authorized generics
  • Exclusions for mandated ASA drugs
  • DAW 3, 4, 5, 6, and 9
  • Non-formulary-excluded brands
  • AB-rated drugs hidden under therapeutic language

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“The performance our partner sold us on wasn’t a lie. It just wasn’t the right transparency we needed.”

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DECISION MAKING FROM THE DRIVER’S SEAT

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The historic market approach above has consequences downstream; it negatively impacts payor groups, customers and ultimately patients. Gateway, on the other hand, is in the business of helping clients make better decisions upfront and delivering on the guarantees we set forth in our initial contracts.

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To us, the right transparency means delivering numbers that you can feel comfortable with and confident in. In order to achieve this, we (1) review your data, (2) model our guarantees based on reasonable expectations, and (3) optimize over time to provide additional upside to your business.

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Most importantly, from our first conversations, we consider negative factors that can chip away at contract promises over time, so we can mitigate them.

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The end result of Gateway’s approach? A customized and specific view of how you can expect your rebate and formulary business to perform. In other words: the right transparency.

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WORKING SMARTER

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You deserve rebate and formulary recommendations that are tailored to your data and business. Gateway can achieve this by:

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  • Providing supplemental data showing market trends and overall impact to rebate/brand performance
  • Adding per-brand metrics to claim-level details in our offer
  • Identifying the “watch out” areas we see in your data that may not lead to optimal performance
  • Working with your teams to identify and correct items to increase program optimization overtime

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We have proven time-and-again that this method of rebate and formulary management can limit surprises for you—and ensures we can remain committed to our contract guarantees. If you want to see how the right transparency can be put to work for your organization, contact us today to talk.

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