Pharmacy Consulting

Healthcare is always evolving

Regulatory requirement changes, new product and service introductions, and other innovations present both opportunities and challenges for employers. Our experts consult, research, and train your team on industry trends, regulatory changes, and overall pharmacy management.

As a full-service consultancy for employers with aggregate drug spend exceeding two billion dollars, we provide the following support:

RFP Services: In a perfect world, what would your Pharmacy Benefit Manager (PBM) provide for you? When it comes to negotiating and finding “the right fit” for your organization, trust our pharmacy benefits management expertise. We work with you to understand your objectives and expectations from a PBM. Our unbiased and independent vendor selection process is designed to find vendors who live up to your requirements. We follow this up with RFP distribution, scoring, recommendations, and vendor selection. Finally, we coordinate the contract negotiations and implementation with the vendor of your choosing.
Contract analysis: We regularly assess PBM agreements, providing valuable insight to our clients. Subtle language differences, seemingly arbitrary to the untrained eye, can significantly impact the overall value of a PBM agreement. We highlight the contract’s strengths and weaknesses.
Market checks: PBM agreement length is often three years or greater and often includes periodic market checks to assure the pricing remains competitive. By stipulating frequent market checks during the RFP process, our team ensures timely review of annual spends in the event changes in the market landscape yield more competitive pricing.
Clinical program assessment: PBMs and medical carriers regularly update their clinical program offerings. We assess these programs and provide tailored recommendations for our clients.
Benefit design assessment and modeling: We assess benefit designs and provide recommendations to address our clients’ overall health benefit objectives. We provide benefit design modification modeling using proprietary algorithms and present them to you in a straightforward manner so you can make informed decisions.
Vendor management: Pharmacy benefits represent a portion of a comprehensive health benefit offering for our clients. For a number of our clients, we help manage the PBM relationship on their behalf to ensure an exceptional experience for their members and optimal plan performance. For larger organizations, managing pharmacy benefits can add up to serious plan savings.
Audits: Pharmacy Benefit Audits work to ensure your business has contract compliance and claims adjudication accuracy. Audits include Pharmacy Claims Audits, Pharmacy Rebate Audits, and Pharmacy Operational Audits.

Solutions Experts

Stuart Piltch

President - Risk Strategies Consulting

Sean Walsh

National Pharmacy Practice Leader

Blog

Pharmacy 2 min read

Foundational Issues Facing the Pharmacy Benefit Manager (PBM) Industry

Pharmacy 2 min read

Peeling Back the Layers of Your Pharmacy Benefit Design

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