The top five places to look for millions of specialty dollars

In the “Tale of two employers.” these employers used two different pharmacy strategies. They achieved two different spend results. There was one clear winner. The conclusion (#spoileralert) was also clear — we know some employers may not understand that they can help employees get the right drugs without sacrificing savings.

Steve Johnson, Prime’s senior director of health outcomes, put it best: “Managing drug costs means saying “yes” to the right tools.”

Having a clear understanding of these five areas of cost control is critical to keeping health care affordable:

  1. Utilization management: Put prior authorizations, step therapy and quantity limits in place to assure members are getting the most clinically appropriate and cost-effective medicines at the right time. Prime’s split fill program helps reduce waste and lower costs for certain oral oncology drugs. It gives members the opportunity to gauge potential side effects before continuing therapy.
  2. Preferred drug management: Encourage use of preferred products and formulary exclusions under both the pharmacy and medical benefit.
  3. Benefit design: Set out-of-pocket costs that drive preferred products, but don’t let cost impact adherence. Prime Therapeutics Specialty Pharmacy™ provides assistance regarding benefit coverage and insurance verification. We help members get the medicine they need without cost or coverage surprises.
  4. Channel management: On the pharmacy side, maximize mail, 90-day supplies and limited networks. Optimize site of care on the medical side. Costs can vary by thousands of dollars based on this alone. Offer patient financial assistance for preferred drugs.
  5. Care/case management: Offer counseling and member services to ensure safe and effective drug use, coordinated care and use of the preferred care network and specialists.

Bring balance to employer/member needs — contact your health representative to learn about promoting bold specialty strategies.

Next: Does your formulary work hard enough?

Prime Therapeutics Specialty Pharmacy™ is a wholly owned subsidiary of Prime Therapeutics LLC.

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