Our Advantage
Q: How is PharmHealth paid? Print E-mail
Wednesday, 12 March 2008

A: PharmHealth only gets paid if your costs go down (on a gain share basis):

  • We receive 20% of the employer PMPM pharmacy plan cost reduction from the prior 12 months for the first two years.
  • After the first two years we get 20% of the difference between the actual cost increase and the increase trend for similar plan designs (nationally as reported by independent publication).
  • The Pharmacy Benefit Administrator is paid a single all inclusive per employee per month fee and gets no other funds from any other sources than the checks you write them. 
 
Q: What does PharmHealth do?

A:  Using our in-depth knowledge of physician and member health issues, PharmHealth collaborates with Pharmacy Benefit Management (PBM) resources to design pharmacy plans that are cost-effective and high in participant satisfaction. We establish a true client based pharmacy plan management group that approves design and has final control, in addition to finding honest and accurate metrics for specific annual plans for improvement. PharmHealth establishes benchmarks for performance and specific annual plans for improvement.

Q: What are the benefits of PharmHealth?

A:  We truly partner with our clients. We show you a comprehensive analysis of how your current plan performs. Through this analysis we show you where you can find immediate cost savings through your current plan design and pricing agreements. We also identify potential cost savings and make design improvement recommendations.

Q: How does PharmHealth do it?

A:  We understand and control the key levers. We don't just try to beat up the PBM. We don't cost shift to members. We don't use mandatory generic or mandatory mail order programs. Doing any of those things gets you poor service and unhappy members and does nothing meaningful to keep costs down (and in fact may actually increase costs). We practice smart Plan Design, smart Formulary Management and smart Pharmacy Benefit Administration. We educate leadership groups to make key design and override decisions and to understand all drug manufacturer contracts with the PBM. We educate the members to better understand their options and alternatives. PharmHealth serves as your agent in managing the PBA requiring not just transparency but relinquished control so the PBA does the right things at the right time in the right way to meet your needs not their own.

Q: What does the analysis cost, what is involved and what will it show?

A:  We’ll perform the analysis for no cost. The first time we meet, we’ll ask you to do two things:

  1. Provide us with the details of your current plan design.
  2. Provide us with four months of complete claim data for all scripts filled.

The analysis will show you how your plan is actually performing:

  1. A cost savings analysis showing what you would immediately begin saving using your current plan design and our pricing agreements.
  2. A potential cost savings analysis showing the opportunity that exists in the plan through our value add consulting and design improvements. 
Q: How is PharmHealth paid?

A: PharmHealth only gets paid if your costs go down (on a gain share basis):

  • We receive 20% of the employer PMPM pharmacy plan cost reduction from the prior 12 months for the first two years.
  • After the first two years we get 20% of the difference between the actual cost increase and the increase trend for similar plan designs (nationally as reported by independent publication).
  • The Pharmacy Benefit Administrator is paid a single all inclusive per employee per month fee and gets no other funds from any other sources than the checks you write them. 
Q: What is smart Formulary Management?

A: Through smart Formulary Management, we work with hospital Pharmacists to design your formulary to the most cost effective treatments, not the highest rebates. 

  • We work with the hospital pharmacist to design the formulary to the needs of your employees - based on your prescription pattern. 
  • We match the drug prices to the actual plan cost. We show the true bottom line plan cost - not just the smoke and mirrors of book value AWP, theoretical discounts, rebate shares, administration fees, etc. 
  • You will know exactly what you’re paying for, all costs will truly be transparent - nothing will be hidden.
Q: What is smart Pharmacy Plan Design?

A: We design structures to steer users to the most cost effective treatments.

  • We pay pharmacies more for filling scripts in a cost effective manner.
  • We change consumer patterns through useful education and helpful consultation:
    • Semi– annual comprehensive benefit statements.
    • Targeted communications educating members on options and alternatives.
    • Targeted incentives to encourage making cost effective decisions.
    • Follow-up letters when consumers make less cost effective decisions.
    • Follow-up with pharmacies that have less effective patterns.
  • We manage inappropriate utilization by challenging users who choose to use less cost effective treatments.
  • We provide more and better information on patients and prescriptions.
  • We give users incentives for filling prescriptions at pharmacies that add value and lower cost.
Q: What is a smart Pharmacy Benefit Administration (PBA) approach?

A: PharmHealth brings the value of unique partnering relationships with participating Pharmacy Benefit Manager’s so that the PBM's truly become PBA's working exclusively on your behalf under clearly defined rules, exactly like your health plan TPA works.

  • Consult and assist in formulary design yet relinquish all control.
  • Guarantee you receive 100% of all fees received from the pharmaceutical companies to the plan sponsor (includes administration fee, access fee, fixed and volume adjusted rebate shares, script change fees).
  • Receive a fixed income in the form of an all inclusive pepm fee paid only from you.  No extra margins from minimum script fees, co-pays in excess of script costs, etc. 
  • Have clear prescribed performance standards and penalties.
  • Are required to pay the pharmacies the exact same amount charged to the plan in every case (something still not happening today, even in "transparent" contracts).
  • Are not allowed to sell or otherwise share any of your information.
  • We review 100% of all claims processed monthly to quickly identify patterns of concern and take rapid action
Q: What does the complete state-of-the-art turn key Pharmacy Plan include?

A: The Pharmacy Plan includes:

  • Dedicated account representatives.
  • Plan design consulting.
  • Contracting.
  • State of the art claims processor handling your plan.
  • Enrollment kits.
  • Pharmacy cards standard or smart cards.
  • Formulary management.
  • Prior authorization management.
  • Sponsor reporting.
  • Employee Communications (newsletter articles, benefit statements, target message letters, etc.).
  • Physician reporting.
  • Pharmacy plan Web site.
  • Consumer and pharmacy call centers.
  • Drug utilization and interaction tracking and counseling. 
  • Disease state management (optional).
  • Workers compensation prescription management (optional).
  • Clinical drug information support.