This section is applicable to employers who self-fund their health care. It can be either through a bundled (carrier) model or unbundled (TPA/PBM).
Pharmacy benefits have become one of the most high-profile areas of employee health plans, from both an economic and a member desirability and satisfaction standpoint. Pharmacy costs have risen 20-25% of total health care spending and are forecasted to reach 50% by 2020. Most of this increase is due to specialty drugs. These are drugs that are often self-injectables and have specific administration whether in a physician’s office or at home. With 3,000 specialty drugs currently in the pipeline, action from employers is needed now to curb escalating costs.
The pharmacy arena is highly complex and many brokers do not have the time or special expertise needed to give their clients the advice they need. At HM, we have the expertise to provide you with the knowledge and counsel on your next move. HM provides valuable differentiation through strategic pharmacy partnerships.
When was the last time you reviewed your pharmacy utilization trends? Our focus is to evaluate (through data analytics and contractual reviews) if the most cost effective contract has been reached with current PBM. Recent analysis has concluded that ongoing evaluations are needed as AWP discounts, rebates, and MAC pricing are consistently re-negotiated in favor of our clients.