Today more than ever, employers are juggling strategies for supporting their employees’ needs and keeping them healthy. As businesses look for saving opportunities in the employee benefits package, consider optimizing your health plan’s pharmacy program rather than simply reducing your health plan benefits. A few changes to your pharmacy program may be one way to achieve your goals.
Are you getting the most from your pharmacy benefits plan?
There are many pharmacy-related cost controls you can expect from your healthcare benefit plan. Your benefits advisor or insurance company should be able to provide data insight into how efficiently your plan is handling pharmacy claims. Combining multiple strategies can assure employers recognize even greater savings. Below are five cost-savings strategies you should consider:
- Utilization management ensures the safe and appropriate use of high-cost specialty drugs by employing prior authorization, step therapy, and drug quantity guidelines. Make sure your insurance company is providing this service for every insured member.
- Claim prepayment reviews validate usage, dose and pricing for each drug that requires utilization management. Double checking these variables can reveal hidden costs that otherwise would go unnoticed.
- Medical claim edits validate claims against clinical standards for those drugs that don’t require utilization management. This process improves patient safety while detecting errors and improving outcomes.
- Site-of-care management ensures members use the most clinically appropriate and lowest-cost site of care. An example of this is providing nurses for in-home infusions instead of in a hospital setting. While most pharmacy drugs are billed through a healthcare pharmacy benefit, costly specialty drugs are often administered in clinics, hospitals, or doctors’ offices and then billed through a medical benefit—increasing medical expenses for you and your employees.
Example: Recently, PHP was able to change a site of service for a member that saved the health plan $120,000 for a single year. Using PHP’s prior authorization process, claims were pre-approved. This allowed pharmacists to see who, what, when, and where medications were being used, providing the opportunity to catch unnecessary pharmacy and medical expenses and offer less-costly, alternative care.
- Online pharmacy options and home delivery
Online pharmacy options make receiving and adhering to medications easier than ever. Features include:
- Maximum convenience
- State of the art dispensing with a focus on safety and accuracy
- Free standard delivery (in weather-proof packaging)
- Automatic refills for eligible medications
- Affordable medication prices (based on your benefit plan)
A Committed Partner
When shopping for a healthcare plan, look for an option with a dedicated pharmacist or pharmacy benefits advisor and a responsive, internal team that will focus on your employees’ wellbeing while balancing cost-savings. This team can help members manage their medications, while seeking alternative ways to purchase and receive medications that are both more convenient and more affordable.
