Prescription Drug Consulting
Premier’s Pharmacy Management unit has over 20 year of experience reviewing, negotiating and managing client’s pharmacy programs with Pharmacy Benefit Managers (PBMs). Pharmacy spend represents about 25% of overall healthcare spend and it is the most highly utilized part of the benefit, with approximately half of all members using the benefit on a monthly basis.
Premier analyzes member utilization and trend in order to determine its appropriateness for that client. As a part of this analysis Premier evaluates member cost share, price discounts, rebates, utilization, and generic dispensing to determine the factors contributing to increasing plan costs. Each of these factors tells a lot about the covered membership as well as how PBM is performing as a manager of the pharmacy benefit. Sometimes big changes create more harm than good, while small tweaks can save thousands of dollars.
Premier also monitors utilization of specialty medications on an ongoing basis. These specialty medications usually cost over $2,000 per month and are prescribed to a very small and sick portion of covered members. Specialty medications currently represent about 20% of total pharmacy spend, but are also 50% of the drugs currently in the FDA patent pipeline. It is projected that specialty pharmacy will be the fastest growing portion of the medical benefit and will reach 50% of total pharmacy spending by 2020.
Premier has leveraged its book of business to negotiate standard PBM pricing which is significantly more cost effective than individual clients would be able to achieve on their own. This pricing is guaranteed, measurable, and reconciled on an annual basis. Along with the enhanced pricing, clients will see higher rebates on a quarterly basis and a more controlled formulary encouraging members to utilize cost-effective medications first.