New Approaches to Rx Costs and Benefits
October 8, 2009
Although in the past many of our clients focused on maximizing PBM financial arrangements to cut costs, they have recently shown interest in efforts that ensure that plan participants are most efficiently utilizing their prescription drug benefit," says Dr. Ritu Malhotra, vice president and clinical pharmacy consultant at The Segal Company.
She suggests using four strategic tools to improve prescription drug efficiency:
- Diagnostic check-ups that provide an incisive review of how a plan sponsor's drug benefit is performing from clinical, financial and plan design perspectives.
- Streamlined financial audits that provide snapshot views of PBM performance against major financial terms (drug discounts, dispensing fees, rebates) assuring delivery at contracted levels. Snapshot reports also provide valuable market benchmark data and identify areas where additional savings can be realized.
- Enhanced prescription drug program analyses fill gaps in information provided by medical vendors and PBMs and provide data for fraud and Rx abuse detection and specialty drug utilization.
- Value-based prescription drug plan design strategies encourage appropriate Rx utilization and help align copays and other out-of-pocket costs with effective chronic disease management and prevention. An example: free medication for diabetics to help them better manage their condition.
Dr. Malhotra holds a Doctor of Pharmacy from the University of the Sciences in Philadelphia College of Pharmacy and a B.A. in Biology from Lehigh University.