Are you a benefits professional with a pharmacy benefit contract set to end in the next year? If so, let's clear up one misconception: You don't have as much time to take that bid to market as you might think.
Maximizing the value of your pharmacy benefit takes a lot of runway, especially for larger organizations. The sooner a decision is made, the better prepared your employees will be for any potential changes. And if Jan. 1, 2020 is your target date to enact new plans, now is the time start working toward that.
The question then becomes, where to begin?For benefits managers looking to start out on the right foot, keep these best practices in mind:
Work with an objective and transparent partner to take your contract out to bid
It's important to ensure that you and your partner's goals are aligned. Many benefits consultants are incentivized to drive clients to in-house coalitions or favored PBMs, regardless of whether or not they are good of a fit for your plan.
Consultant coalitions often have steep joining fees as well as ongoing PEPM, PMPM, or per-prescription fees that aren't initially reported on. Plan sponsors should be encouraged to ask their consultants, "What percent of your RFPs finalize with the contract being awarded to a coalition contract?"
Additionally, RFPs are typically run manually, which opens the process up to individual bias that can be overcome when working with a technology-enabled partner.
Expecting objectivity and transparency from your partner ensures their first priority is finding you the most appropriate contract for your membership.
Go through multiple rounds of bidding
The first offer is rarely the best one, and that’s especially true when it comes to bidding out contracts. PBMs should be continually competing for your business instead of drafting cookie-cutter contracts and expecting you to accept them.
Opening your contract to a bid with multiple rounds demonstrates to PBMs the need to reduce prices and optimize contract terms to meet your needs
Leverage a combination of technology and pharmaceutical expertise
While it is vital to have a pharmacy benefit expert manage your contract, deep domain expertise, alone, isn't enough to find the best contract savings. You want your pharmacy benefit advisor spending time focusing on the big picture instead of manually populating excel-based pricing models that only look at a subset of bucketed claims.
By using a pharmacy benefit partner that leverages technology-enabled solutions along with industry expertise, you get the confidence of accurate, efficient, and objective analysis of the a pharmacy benefit offer.
Technology can’t and shouldn't replace pharmacy expertise, but it can augment it significantly. Don't be afraid to embrace new ways of tackling your pharmacy issues — it can save you time and money.
Understand your data rights
It can be surprisingly difficult to access your own claims data, to your detriment. Independently auditing your plan's performance, market checks, and procurement exercises are difficult without that information at hand.
Don’t let yourself get locked into terms that don’t give you access to your company’s own data. With access to your claims data, you have the freedom to explore solutions with your vendor of choice to make the most informed decisions for your members moving forward.
Choose a contract you can manage continuously
Make sure you are proactively monitoring your PBM's performance so you don't overpay. It's important to review pharmacy claims on an ongoing basis to ensure you and your members are being billed accurately and that you receive the full value of pricing guarantees.
Make sure you're protecting yourself and your members with a service that is able to analyze your claims data at the individual claim level and lets you know when anything goes wrong.
You should also consider leveraging market checks mid-contract to ensure your PBM pricing is aligned with market rates.
The bidding process is long and complex, but with the right tools and expertise at your disposal, you can abide by these and other best practices even with an abbreviated timeline and small staff. For contracts set to expire in 2019, there is still time to start the bidding process.
Your contract's expiration date is coming up sooner than you'd like. Reach out to start the process now before you find yourself up against the clock.