Are you confident that your pharmacy pricing data is secure? Relying solely on your vendors isn’t enough. It’s crucial to know the right questions to ask and the best times to ask them. Our Pharmacy Guardian consulting services assist you with developing a robust strategy to safeguard your interests.
Use the expertise of our pharmacy specialists to conduct a thorough gap analysis, identifying any areas of risk exposure.
The essentials
- Strong governance structure: people, processes and monitoring
- Policy statements (vendor oversight, plan expenses, training)
- Documented procedures
- Up-to-date compliance calendar
- Appropriate providers
Partner with us for comprehensive audits and contract negotiations to reduce costs for you and your members.
Auditing
We offer a full range of audit services, such as complete reviews of pharmacy claims, rebates, clinical assessments and pre- and post-implementation support:
- Due diligence — carry out your fiduciary duties as spending on pharmacy benefits is a sizable portion of employee-related expenses.
- Our audits have found overpayments for both the employer and employees. We can help fix these problems and prevent future mistakes.
Navigating to lower-cost options
We offer resources and strategies to manage high-cost categories more efficiently by directing members toward more affordable pharmacy options:
- Premier partnerships — we work with top pharmacy benefits manager (PBM) overlay vendors, including Rx Savings Solutions and Scripta, to improve our service offerings and provide significant cost savings.
- We help clients create special communication campaigns to inform members about biosimilars. These campaigns may help patients get better results and save money.
- Drug price variance analysis is used to benchmark against acquisition cost and other models. The analysis is designed to help address important considerations such as:
- Are overall drug prices under our plan in line with the actual cost of the drugs?
- How do prices of drugs dispensed under our plan compare to acquisition cost?
Request for proposals and contract negotiations
We provide you with expert guidance, access to an extensive benchmarking database and proven cost-saving strategies:
- Using our extensive benchmarking and pricing database that includes more than 1,200 agreements, we’ll help you negotiate top-tier pharmacy contracts.
- We have a deep understanding of PBM contracting, ensuring expert guidance and strategic insights.
- Our clients have saved more than 16% on requests for proposals in the past year. This shows that our cost-saving strategies work.
Compliance and communications
- Operational and compliance reviews
- HIPAA reviews
- Discrimination testing, mental health parity assessments
- Ensure plan documentation is up to date and in compliance with the latest standards (e.g., SPDs, plan documents)
- Review of employee communications
We consult with you directly to understand your needs and priorities. This is our first step before considering any approach or solution.
