Your Pharmacy Benefits Short List for 2022

Many of you, particularly those in Human Resources and Finance, are getting ready to or are scheduled to review your pharmacy benefits arrangements.?Couple thoughts:

The player within your line up of benefits provider responsible for your pharmacy benefits is retained primarily to contain pharmacy costs.?They do this is in a variety of ways, including negotiating pharmacy discounts, pharmaceutical manufacturer contracting, drug utilization management and automating administrative services.?

Here’s the catch – The agreements you sign with PBMs have a varying degrees of transparency.?Ranging from, you guessed it, radical transparency to completely opaque.

If you do nothing else this year in reviewing your current PBM or those you’re talking to, do these three things:

(1)?????Determine if your agreement is constructed using spread-based pricing.

(2)?????Secondly, identify what programs, automated and otherwise are available to offset the cost and manage specialty drugs that are paid through your health plan.?Yes, you heard me correctly – your health plan.

(3)?????And, finally, determine your forecasted utilization.?COVID-19 may have depressed your overall utilization – Carriers and PBMs have reported that utilization of outpatient care was down in 2020 – But what does 2022 look like for your plan?

As I’ve mentioned before, these conversations require specificity and you’ve got to have the right professionals in your corner to ensure all boxes are checked.

We’re here to help.?If you’d like to dig deeper into these conversations, let’s talk.

The Kinetiq Health Pharmacy Benefits Consulting practice offers a team of in-house Certified Pharmacy Benefit Specialists (CPBS). This team — the largest and most experienced in the state and led by an in-house licensed pharmacist — helps our clients derail escalating pharmacy costs and gain increased transparency in pharmacy benefit management (PBM) contracts.?

You can find me on here on LinkedIn or at slong.apexbg.com