Managed Care - May 2008 - (Page 43) How MCOs Can Get Optimal Value From Their Pharmacy Benefit Managers There is no one-size-fits-all contract, says a senior executive at Prescription Solutions. A PBM can perform many functions. savings will not come from lowering administrative fees or eliminating PBM rebates. The most significant cost savings will come from improved utiver the past decade, a growing number lization of prescriptions for better health and from of managed care organizations have the avoidance of unnecessary medical services that come to view pharmacy benefit manresult from inappropriate drug use, noncompliagement companies as more than just ance with drug therapy, or adverse drug reactions. vendors or sources for purchasing discounted drugs For example, the average senior beneficiary and administering claims. As health care confills 6 to 8 prescriptions per year. Reducing the tinues to become more complex and costly, number of inappropriately filled prescripthese MCOs recognize that to provide optitions by one per member per year could save mal value, PBMs must become an engaged the average MCO hundreds of thousands of partner in the effort to manage critical cost dollars each year, according to our data. drivers. Utilization management of prescription However, the PBM industry can be comdrugs does not mean restricting access to plex. PBM strategies and techniques may not needed therapies, nor should it create a be fully understood. To negotiate the best process that is cumbersome and frustrating value, an MCO should seek a collaborative John D. Jones, RPh, JD for physicians and members. The best utipartnership with an organization commitlization management programs incorporate ted to working with its clients to provide edstrong clinical management designed to decrease ucation on standard industry practices, improve the incidence or severity of high-cost, high-impact quality of care and safety, and secure the lowest diseases such as cancer, diabetes, and heart disease. net cost for prescription drugs. To reach these goals and develop optimal relationships with PBMs, look for these attributes: One MCO’s experience To provide even greater value, these programs • Strong clinical and utilization management should also help MCOs use appropriate drug therexpertise apies to control medical expenses, including hos• Alignment of incentives for a collaborative pitalizations and ER visits. Most importantly, utiworking relationship lization management programs should be focused • Wide array of choices and options for strucon benefiting the plan members, providing them turing the relationship with real value from the pharmacy benefit by en• Transparency in pricing and business pracsuring that they have full access to the drugs that tices • History and reputation for integrity John D. Jones, RPh, JD, is senior vice president for professional practice and pharmacy policy at PBMs have a proven record of accomplishment Prescription Solutions, which manages prescription in helping MCOs contain both medical and phardrug benefits for commercial, Medicare, and govmacy costs. The pharmacy trend (rate of increase ernmental health plans, as well as for employers, in pharmacy costs) fell for the second consecutive union trusts, and third-party administrators. year in 2007, and there are still opportunities for Prescription Solutions can be contacted at greater savings and value. It begins with an under888-398-5189 or information@rxsolutions.com. standing of the key factors that drive costs. Real cost The web site is www.prescriptionsolutions.com. By John D. Jones, RPh, JD O MAY 2008 / MANAGED CARE 43 http://www.prescriptionsolutions.com
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