We attend to your organizational health so you can focus on patient’s health.
The pharmacy benefit is one of the larger and more complicated features of any healthcare benefits package. It can be a challenge to stay informed about issues that affect your plan, making it all the more difficult to ensure your pharmacy benefit is delivering the most value to your organization and, most importantly, your employees.
The Gallagher’s Pharmacy Benefit Management (PBM) Consulting team is here to help. We leverage our real-world expertise and clinical insights to keep you up to date on issues that may impact your prescription drug plan. By assessing your current PBM contract, we partner with you to tightly design your next one, along with providing ongoing consulting focused on audits, managing costs and increasing plan satisfaction. And we don’t stop there. We conduct ongoing proactive strategic consulting including utilization studies, contract reviews and a deep dive into understanding the specialty drug pipeline, so you are constantly improving your programs.
The result? An organization powered by a healthy and engaged workforce, with potentially lower costs for you and your employees and a contract that is optimized for a constantly changing environment.
Pharmacy benefit programs are increasingly difficult to manage due to industry changes and skyrocketing drug prices. These circumstances affect your ability to negotiate lower costs for prescription drugs and manage drug utilization, which is becoming an increasingly higher percentage of overall healthcare spend, representing nearly 30% of total healthcare costs.
Gallagher’s Pharmacy Benefit Management (PBM) Consulting team has cracked the code for identifying cost savings through savvy contract negotiations and precise auditing. We can help you better manage your prescription drug plans by utilizing a number of different tactics, tailored to the unique needs of your organization.
Your pharmacy benefit is only as good as your contract. When you partner with Gallagher, you have the power of first-hand knowledge of the pharmacy business model, which allows for unparalleled evaluation of pharmacy contracts. Together we’ll evaluate your options to uncover the best possible deal with fair, flexible and auditable contractual terms, without compromising on employee satisfaction and quality of care.
By partnering with Gallagher you will be able to guarantee that your pharmacy benefit is meeting contract obligations and paying claims accurately. Our plan financial reporting services provide a summary of your plan cost and analyze how and where those costs are occurring. This data drives further optimization of your pharmacy benefit – helping your plan deliver healthy performance and a healthy, engaged workforce.
To help our clients under 3K lives gain better pricing and servicing options, Gallagher has developed a pharmacy coalition. The Gallagher Pharmacy Alliance is designed to specifically to provide smaller employers with better pricing and services than they would be able to access on their own. This is a good option for:
A large, self-insured benefit trust asked us to assess the quality of services provided by a national PBM and their specialty pharmacy for members who were receiving high cost medications for complex medical conditions. To understand the costs, we had to review a high cost claimant who received multiple medications (Firazyr, Cinryze, and Berinert) for the treatment/prevention of hereditary angioedema (HAE).
We conducted detailed case evaluations of the PBM’s and specialty pharmacy’s records. These records documented the clinical services provided to patients who had received specialty medications. It also shared the evaluation of routine follow-ups for medication refill coordination, routine screening and assessment by a pharmacist or healthcare professional of medication-related problems, clinical interventions, and care coordination.
We were able to find several ways to improve service and keep costs the same. The PBM and their specialty pharmacy took the several steps to enhance their clinical support services and care coordination efforts based on our findings: