The health care benefits your company offers its employees is an investment in their well-being, satisfaction, and productivity. That said, it can also become prohibitively expensive as you find you’re spending more and more every year. One area where LHD has had great success is finding savings by examining your existing Rx plan and recommending changes to lower costs. Our approach to pharmacy costs and prescription benefit analysis is a straightforward process that can have a big impact in reducing your Rx benefits spending.
Why Focus on Pharmacy Costs and Prescription Benefit Analysis
Employers across the US feel the pain of the rising cost of healthcare and health insurance. This was a serious problem for any company’s employer providing health benefits even before the coronavirus pandemic. According to a report on a Kaiser Family Foundation study (source), in 2019 the average cost of a family health plan had increased 22% over five years, and 54% since 2009. They also predicted employer health benefits would continue to grow by at least 5% annually in years to come.
These increases put employers in an awkward position of wanting to help employees get the medical care they need while at the same time trying to exercise some control over the upward spiral in cost of the company’s health benefits plan. Today’s employers must leave no stone unturned in the search for ways to control costs while still meeting employee healthcare needs. It’s also worth noting that back in 2019, pharmacy benefits accounted for 21 cents of every dollar spent on healthcare. This is why LHD offers a critical Pharmacy and PBM Analysis Service to dig into pharmacy costs and prescription benefit analysis and find opportunities for changes that will save money while still ensuring every employee gets the prescription drugs they need.
When the Data Speaks, LHD Listens.
Among the most important features of life in the twenty-first century is the power of data. Modern software applications, connected devices, and the cloud have resulted in an ever-growing volume of data beyond anything we could have dreamed of in the twentieth century. LHD recognized early on how “big data” represented one of the richest opportunities to be more strategic in the development, intentional design, implementation, and ongoing monitoring to help clients achieve high-performing health benefits plans.
What we bring to the table is a proactive approach to leveraging insights gained from advanced data analytics into strategic actions that get clients better results by finding ways for health and prescription drugs to meet the needs of employees while at the same time controlling the ever-upward march of cost. When you partner with LHD, you’ll have the peace of mind that comes from knowing we are constantly analyzing data, tracking trends, and coming up with recommendations for making changes that get impressive results. That’s our promise to you.
Elements of the LHD Pharmacy and PBM Analysis Service
Two critical components of our pharmacy costs and prescription benefit analysis service include contract analysis and ongoing monitoring of your Rx plan performance analysis.
Contract Analysis for Employer Provided Pharmacy Benefits
If you’ve ever tried to do your own deep dive review of a pharmacy benefits PBM contract, then you know it can be a mind-numbing experience. They’re long and have lots of fine print, complex caveats, and ambiguous language that makes everything sound great when it’s not. The well-worn adage of “the devil is in the details” is very apt when it comes to the pharmacy benefits contracts of PBMs. LHD keeps ahead of the curve on contract trends in order to help our clients make better decisions and negotiate higher-quality contracts that will improve their pharmacy and prescription drug benefits plan performance to optimize benefits for employees while controlling the cost.
Should you go with a traditional contract or go for the more recent pass-through style of contracting? Are average wholesale price (AWP) discount guarantees structured in a way for the plan sponsors to gain the full discount or is the PBM benefitting by keeping some of the discount? Is the PBM taking a spread-based revenue approach that makes it more difficult to figure out what the PBM is earning and that also creates auditing challenges? How are rebates handled in the contract? These are just a few from a long list of questions that must be answered in order to evaluate and compare different contracts. The good news is you don’t have to try doing this on your own. LHD has the expertise and tools to do it for you.
Monitor Rx Plan Performance Analysis Service
When it comes to Rx plan performance, the last thing you should do is take a “set it and forget it” approach. The world of healthcare and health benefit plans is in a constant state of flux. The only way to controls costs and while still meeting the needs of employees is to constantly monitor Rx plan performance. This is part of the LHD pharmacy and PBM analysis service.
By continually analyzing the data and tracking Rx plan and PBM trends, LHD proactively finds opportunities to make impactful changes to ensure what you have is a high-performing Rx plan. The often-missing link LHD provides is the integration of population health data analysis to anticipate changes in risk as the health of your employees changes over time and the mix of employee health characteristics shifts as workers come and go. For example, if a change in the population health of your workforce results in more employees needing specialty drugs, it may be time to see those can be managed differently through strategies such as carve-outs, Rx help centers, and so on. These are the kinds of things LHD is always keeping an eye on for you, so you don’t have to.
It’s a complex web of data sets that must be analyzed in a wholistic manner to keep proactively ahead of what’s happening now and what’s coming in the future.
LHD Results Speak for Themselves
Remember the rising costs of prescription drugs and pharmacy benefits we referenced based on what was happening in 2019? We want to highlight how that was also the year LHD saw an opportunity to recommend an important change in the approach to PBMs (prescription benefit managers). The result of that change when implemented was a full 20% reduction in Rx expenses. Just this one change saved our clients millions of dollars.
This is the kind of win LHD loves to celebrate with clients. It comes from our tireless focus on data and trends, a meticulous focus on details, and our commitment to do right by our clients. If you’d like to find out more about what LHD can do for your company around health benefit plans and prescription drug benefits, don’t hesitate to get in touch through the Contact Us page of our website, or give us a call directly by dialing 317.751.7049. We’re eager to get results for you!