Pharmacist / PBM Analysis

EFFECTIVELY MANAGING PHARMACY COSTS

BUSINESS PROBLEM:

• The vast majority of self-funded employer groups lack the information needed to purchase Pharmacy Benefit Manager (PBM) services consistent with procurement ideals.
• The majority of PBM procurement decisions are made based on summarized experience data and direct comparisons between pricing terms (e.g. highest discount or rebates).
• Benefit directors typically lack cost projections that accurately model PBM contracts.
  • Contract decisions should not be made in the absence of claim-level re-pricings for the most recent year of pharmacy data (submitted by each bidder) to include:  administrative fees, discounts, dispensing fees, and rebate terms.
• Seitlin Benefits, with our Pharmacy Director, Armand Dilanchian, R.Ph can evaluate your current program and help design programs with improved dispensing and cost results.
• We will evaluate your clinical programs
  • Prior Authorization
  • Step Therapies
  • Quantity Limits
  • Controlled Substance Monitoring
  • Drug Utilization Review and monitor and ensure the your return on investment
• Effective benefit design can both reduce costs and promote appropriate drug utilization.
• Your Seitlin Rx program will be based on your specific data and will properly balance the cost with your employees.