What It Really Means to Optimize Pharmacy Benefits


A lot of times people ask, what is RxBenefits? In the past, we would answer that by stating what we are not, instead of what we are. We are not a PBM. We are not just an administrator, nor just a coalition. So what are we? We are a Pharmacy Benefits Optimizer (PBO).

When you think of pharmacy and the value of our organization, there really is three buckets. (In complex subjects, it helps to break it down a bit, and pharmacy certainly is complex.) So you can think about in terms of the contract bucket, the clinical bucket, and the service side. At RxBenefits, that’s the way we view it – and we want to optimize each of those buckets.

  • On the contract side, we offer one-year pricing, client-specific guarantees, and we are going to optimize that contract in both the pricing and even more importantly, the language.
  • On the clinical side, a lot of times in pharmacy arrangements, everything is left up to the PBM. For us, we think that the clinical piece has to be optimized outside of the PBM. We’ve taken those functions inside RxBenefits. That includes everything from handling prior authorizations to really tailoring the formulary into the client’s favor, not the PBM’s favor – and doing everything we can to put their utilization and management of that utilization in the best interest of the client and their members, not the PBM.
  • On the service side, we optimize that as well. In the PBM arrangement, or even if you have a carved-in arrangement through a carrier or TPA, you are relying on them for service. The problem is that service has not been a strong suit for any of those entities. What we’ve done is pulled that away from them and really fine-tuned it. That goes for everything, from handling how you implement a group, how the group is managed, how the reporting is delivered, but the key to it is how we handle the member experience.

We like to talk about it as an experience, where we are taking that experience and optimizing it for both the client, you as the consultant, and then most importantly, the member. We are making it much personal for each one of them.

Download a visual representation of the pharmacy benefits ecosystem to show your clients and prospects how the current market influences are putting them at a disadvantage – and how partnering with a PBO can give them a new advantage.

 

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