Pharmacy Management
Our goal is to analyze prescription trends, leverage client data, benchmark against industry standards, and effectively manage costs. We achieve this by ensuring that the pharmacy network offers broad access and convenience for employees while maintaining cost-effectiveness. We negotiate with pharmacy benefit managers (PBMs) to secure competitive pricing, discounts, and rebates. Additionally, we collaborate with PBMs to ensure the formulary includes appropriate medications and promote the use of lower-cost alternatives. We also focus on managing specialty drugs to address the high costs of biologics and complex medications.
Negotiate & Oversight on Pharmacy Contracts
PBM contracts usually range from one - three years. It’s important to stay on top of your contract and utilization trends. We will hold PBM’s accountable by reviewing pharmacy claims to ensure contract terms are being met and managing the PBM rebates.
Consider utilization management for GLP-1s. Cost Management Strategies
Specialty drugs account for a large percentage of overall health care spending. Engage with specialty pharmacies and consider specialty cost containment solutions such as manufacturer copay assistance solutions. Specialty Drug Management Regularly monitor claims data and conduct utilization reviews to identify patterns of high specialty drug usage. This can help identify opportunities to switch to lower-cost alternatives, optimize therapy regimens, and prevent overutilization. Utilization Management Biosimilars typically cost less, with an average savings as high as 45%. Encourage the use of biosimilars when available, as they offer a cost-effective alternative without compromising clinical outcomes. Consider utilization management for GLP-1s. Rx Management Programs Plan design plays a vital role in optimizing pharmacy benefits. Yates will work with your pharmacy benefit manager (PBM) to ensure that your formulary is optimized, with a focus on cost-effective specialty medications. Plan Design & Formulary Management
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