With the new budgetary concerns that school districts are facing, due to the economic and pandemic environment, there are a number of things they can do with pharmacy benefits to lower their overall benefits costs. However, when considering the right benefit strategy for your school district clients, it’s most important to consider the current service arrangement and how the members are handled, and if a new or potentially different solution would match or improve that service experience.
If you plan to implement any clinical programs to optimize the prescription drug utilization of the school district, you need to consider what the impact of that will be on the membership. It’s often much less of an impact than you would expect, but it’s something that should be considered in the strategy phase to really understand what the member experience will be and how it may improve while landing with utilization that results in better medications for members and at a better cost for them as well.
Optimizing Purchasing Power: It’s a common misnomer that having 3,000-4,000 member lives (which most school systems tend to have) gives them all the size and scale they need to get a great deal in the pharmacy world. In actuality, because the three largest purchasers of pharmacy comprise over 80% of the market share, school districts really need to have an aggregate purchasing deal to combine that school district’s utilization and spend with a number of other employers to get the most competitive discounts, guarantees, and contractual terms in the market.
Aligning Contract and Clinical Performance: From a discount and guarantee perspective, you need to make sure they are in an aggressive and market-competitive arrangement. They also can optimize the formulary to a pretty good extent. Nearly every school district has some sort of medication utilization that is particularly expensive but has lower-cost alternatives – either over-the-counter alternatives that would save the member and the plan money, or cheaper generic or brand products.
Switching to a Carved-Out Pharmacy Benefits Contract: It’s also not too late to execute on a strategy to carve-out pharmacy for 2020 and 2021. At RxBenefits, we implement clients off-cycle all the time, so effectively every month of the year, we can have a client start with a carve-out strategy. All of the heavy lifting is done by RxBenefits and our implementation team. There is a very detailed process where the plans are tested pre- and post-go-live to make sure the members and the plan are going to have the experience they intended.
These are the kinds of things school districts can consider to really pull the levers and push the buttons on their pharmacy benefits to ensure they are spending money where they should be and not wasting money on unnecessary medications.
We have the ability to help you look at these opportunities for your school district clients and execute on a better financial, better service, and a better clinical strategy at any time of the year.
Check out our case study on how a school system saved money on their pharmacy benefits costs while maintaining member access to appropriate medications.