In an increasingly employee-centric labor market, offering clients a robust but affordable health benefits package is crucial for client satisfaction and retention. Recognizing that pharmacy is both the fastest-growing component of healthcare spend and a benefit that’s quite complex to manage, navigating the maze of pharmacy options can prove quite difficult. Making the right recommendation is critical, considering the overall impact a bad decision could have on a client’s benefits budget.
In the battle against skyrocketing and unrelenting increase in pharmacy benefits costs – a pharmacy benefits optimizer (PBO) is a benefits advisor’s staunchest ally.
RxBenefits is a PBO.
But what is a PBO?
A Disruptive Business Model
In a market ripe for disruption, PBOs have emerged to operate independently of PBMs to advocate for brokers and self-insured clients. They make it easier to carve out pharmacy benefits, serving as a trusted advisor.
Sometimes confused with coalitions, PBOs do more than aggregate lives to secure better rates and rebates. In addition, they take over clinical management, account management, and member services from the PBM and deliver these services independently. Because of this powerful combination of capabilities, PBOs are uniquely able to manage self-funded plans to the lowest net cost while dramatically improving the customer and member experience.
Unlike integrated carriers and PBMs that may be conflicted by their own profit motives, PBOs operate free from perverse financial incentives, advocating on behalf of the client and its members to deliver a best-in-class benefit at an affordable price.
Data-Driven Personalized Recommendations
PBOs leverage sophisticated, proprietary claims analytics platforms to review plans’ pharmacy utilization history and identify potential savings opportunities. Operating objectively and in the plan’s best interest, a PBO will pull back the curtain to determine how well the employer’s current pharmacy plan performs, according to its existing contract.
RxBenefits’ exclusive Marketplace allows brokers and clients to compare multiple PBM offers side-by-side revealing the potential member impact associated with each offer. A PBO like RxBenefits provides richer insight into the true net savings potential of various PBM offers, significantly outperforming the accuracy of spreadsheets.
An Independent Clinical Expert
By applying deep and independent clinical expertise, a PBO provides each client with tailored utilization management recommendations and laser-targeted strategies to help meet their cost-savings and health outcome objectives.
By focusing on the 2% of members who drive more than 50% of the typical plan’s spend, independent clinical management eliminates wasteful spending while ensuring members can access clinically effective, safe, and cost-efficient medications.
Learn more about how RxBenefits’ advanced clinical management protects plan spending, as well as member outcomes.
Utilization management driven by independent, licensed clinicians ensures clients can feel confident that all decisions are made by experts with the member’s health and safety, and not PBM profits, in mind.
Next-Level Service for All Stakeholders
A PBO like RxBenefits acts as an extension of each client’s team – providing swift, hands-on account management and easy, self-service tools for brokers to manage their books of business, clients to manage their benefits plans, and members to manage their health.
A Pharmacy Benefits Industry Edge
The rising cost and risk associated with pharmacy benefits are unsustainable for self-funded plan sponsors, many of whom are looking for an alternative to the traditional PBM model. Benefits advisors and their clients need a pharmacy benefits partner they can trust to operate in their best interest, free of financial conflicts and the misalignments that otherwise dominate the industry.
