Based upon years of experience, we have an exceptional relationship with the most prominent Pharmacy Benefit consulting firm in the country. For the past 22 years, they have negotiated and developed the strongest PBM contracts in the country on behalf of brokers and self-funded clients.
How We Work
We utilize a combination of Pharmacogenetics and Leverage Contracting Blueprints, coupled with the ability to eliminate “waste in the system,” that is typically embedded in the average PBM Contract. Their Rebates/Discounts, independent clinical programs and strategic interventions are among some of the strongest in the industry.
For more than 20 years, many school districts, creditable associations and employers have maximized carving the Rx Component away from the carriers with their ROI of 20% plus savings - with recommended “Self-Insured PBM Strategies.”
This contract has been in place with the “New Jersey Hospital Association,” for over 20 years, as they have qualified and quantified a 20% Cost Savings Opportunity during this tenure.
Understanding the PBM Contract
If the average broker does not completely understand the following below components of a PBM Contract, they run the potential risk, of possibly losing their Self-Insured Clients, once their clients find out that this strategy is possible and most definitely exists.
· Name Brand & Generic Algorithms
· Step Edits
· Rx Adherence/Medication Therapy Management
· Therapeutic Equivalence Evaluations
· Rebates & Discounts
Important Note: The most common objection from a broker will be, “My client will receive a penalty for carving out the Rx Piece in a Self-Insured Platform.”
However, with that being said, the Savings Opportunity is so profound, that the penalty is so insignificant when the bottom line is finally calculated.
Under these unprecedented financial circumstances that the economy continues to fight against this invisible enemy, the Coronavirus, ignoring this opportunity is simply irresponsible. The Brokerage Community is always held accountable, to the point, that the CFOs, CEOs, and Clients, will eventually ask their brokers, “If you knew this opportunity existed, why would you not share it with us?”
There is still time to protect and make an impact for the next renewal for these prototype businesses with additional savings, exceptional service and unsurpassed oversight!