Our clinical pharmacists focus on total costs and whole patient care, recognizing the essential role drugs play in managing total health care costs and overall patient care.
We collaborate with your owned pharmacies, prescribers and medical plan to develop and implement strategies that are most effective for your plan and your members.
If we deny a prior authorization, we will recommend therapeutic alternatives that fit with national practice guidelines and reduce plan costs to ensure that a member’s needs are still being met.
Pharmacy Resource Optimization
The Pharmacy Benefits Illuminator leverages your pharmacy ecosystem (purchasing, prescribing, dispensing and coverage of prescription drugs), ensuring that there are integrated and aligned incentives for your drug purchasing program, on-site pharmacies, clinical practice, employee health plan, and its members.
Health systems have invested in their pharmacies and electronic medical record to ensure the provision of high-quality patient care.
In addition to a primary benefit to their patients, many self-insured hospitals’ on-site pharmacies provide a significant benefit to their employees through more coordinated care and uninterrupted access to medications.
While your pharmacy benefits may be passed through in your on-site pharmacies, you are missing significant savings if your PBM isn’t passing through actual costs from other retail pharmacies.
By leveraging your preferred acquisition strategy, you can benefit your health plan and your employees can pay the same submitted cost of a product as the PBM and an on-site pharmacy.
If you don’t have a true pass-through pricing plan, your health plan is paying more than the pharmacy is reimbursed for dispensed medication.