Finding the Right Fit
Three PBM Options to Meet Your Clients’ Unique Needs
Employers are regularly challenged with finding the right balance in offering a benefit plan that offers appropriate access, coverage, service and cost. While these challenges are common among employers, the priority placed on each can differ, leading to a need for choice in PBMs. Like clients, the PBMs also place different priorities on these aspects of their solutions based on the customers they wish to attract. We recognize these varying priorities and are pleased to offer our clients three distinct offerings: CVS Health, OptumRx and EnvisionRx
These agreements offer employers and plan sponsors contracts negotiated and written by our team of attorneys and PBM experts, containing straight forward and market-leading pricing guarantees, diverse network and formulary management options and robust service and performance guarantees. We encourage discussions early and often to ensure we are matching the right solution for you and your client’s priorities.
With our continued growth we are able to add additional team members to support our goal of helping clients achieve better outcomes and better experiences at a better cost. Our clients benefit from custom clinical solutions developed by Employers Health’s team of clinical pharmacists. Over the past four years, the team has discovered multiple opportunities to implement custom clinical solutions ensuring appropriate use and exclusion of high-price, low-value drugs.
In all instances, the Employers Health strategy was a forerunner to changes ultimately made by the PBM, in this case CVS Health. Early adopters benefited from years of savings prior to those employers who did not implement these options. For 2020, the team has identified three new strategies for dry eye, probiotics and expensive dosage forms. These solutions represent the unique value of Employers Health’s contract flexibility and the work of our clinical team.
Employers Health Clinical Strategy Timeline
When Brands are Used as Generics
These claims show within the data as multi-source brand drugs. The challenge for employers and their consultants is to identify these claims within the data using the DAW field and ensure that the PBM contract states specifically whether these claims are priced and reconciled as brands or generics, including whether or not they are counted in rebate guarantees. For many contracts, DAW 5 claims are considered generic drugs and patients pay the generic copay even though a brand drug was dispensed.
|CARRIER NAME||TOTAL BRAND RX||TOTAL DAW 5 Rx|