Lowering Drug Costs with a Pharmacy Benefit Management Partner By David Zanze, Executive Vice President of Western Growers Assurance Trust When Western Growers Assurance Trust (WGAT) was launched in 1957, our mission was to give Western Growers members an affordable option for health care benefits by offering highly customizable benefit plans to meet their diverse needs. WGAT, together with PinnacleRx Solutions (PRxS), continues to find additional ways to help employers save money on their health care costs each year.
According to a report by the American Society of Health-System Pharmacists, overall pharmaceutical expenditures in the U.S. grew 4.9 percent in 2020 year- over-year, for a total of $535.3 billion. Plan members use pharmacy benefits more than any other benefit, so choosing the right PBM is more critical than ever. PRxS is a full-service pharmacy benefit manager (PBM) that helps lower a company’s pharmacy costs while improving the quality of benefits available to employees. PBM Benefits PBMs coordinate with manufacturers, wholesalers, pharmacies and the health plan to make sure drugs are administered correctly and members aren’t overpaying. PBMs also help educate members about their pharmacy benefits and improve health outcomes. Additional benefits include: Monitoring, Reporting and Transparency. Monitoring drug usage is critical to containing costs. PRxS believes in full transparency, and our financial reporting shows details of costs, discounts and rebates. Formulary Management. Every PBM will recommend a different formulary, and your PBM should actively manage your formulary. PRxS has a broad formulary, which enables members to keep their current prescriptions during the transition from their previous PBM, so there’s no disruption. Unlike most PBMs, PRxS can also create a custom formulary to meet a client’s needs and maximize savings. As a pass-through model, PRxS doesn't earn revenue on the drugs in the formulary, which allows us to recommend drugs at a lower cost. Identifying Wasteful Spending. A PBM can also work with you to understand frequently used medications and drug classes to help identify wasteful spending. For example, combination products are those that combine two existing medications, resulting in a drug with significantly higher costs and little advantage. In some cases, combination products can drive up costs an estimated 800 percent over individual drugs. The PRxS Advantage PRxS takes a consultative approach to fulfill member pharmacy benefit needs, maximize cost savings and improve patient outcomes. Our on-site
licensed clinical pharmacists conduct full reviews and have close relationships with members, doctors and pharmacies. Here are a few ways PRxS has provided value to its clients: • In 2018, PRxS implemented a prescription drug cost control program to ensure clients and members were optimizing cost-savings opportunities through drug utilization review, step therapy, determining medical appropriateness and engaging in clinical interventions. The program has since saved WGAT more than $3.3 million. • Our co-pay subsidy program assists the most vulnerable members with co-payments and co-insurance for high-cost drugs. We work with drug manufacturers to capture available manufacturer subsidies and pass them along to our members. The program has enabled our WGAT members to save more than $1 million year-to-date. • We design our formularies to ensure generic products are dispensed whenever available, if suitable for treatment, which decreases the cost of prescriptions. • We’ve improved medication adherence rates significantly by working with members and providers to decrease barriers to fill prescriptions. Our medication adherence rate went from 70 percent in 2016 to 86 percent in 2021, resulting in a 3.4 percent total savings across all pharmacy claims, or $884,668 . • Our Enhanced Diabetes Program has enabled us to work closely with our Pinnacle Health Management team to improve the quality of life for our members and reduce the costs of medical care. The program has shown a 4.5 percent savings on diabetes-related medical claims and a 28 percent savings on diabetes-associated pharmacy claims. If you don’t have a WGAT plan, contact Western Growers Insurance Services for more information and see how we can help you better manage your health care costs at (800) 333-4942. In addition to serving as executive vice president of Western Growers Assurance Trust, David Zanze is the president of Pinnacle Claims Management, Inc.
JANUARY | FEBRUARY 2022
Western Grower & Shipper | www.wga.com
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