A recent post by Brian Thomas from TripleTree highlighted Pharmacy and PBM Solutions as a “Top Trend” in employer sponsored healthcare. More specifically, Thomas describes specialty drugs as one of the largest drivers of healthcare cost increases over the past several years and blames PBM consolidation as a factor in less competitive pricing and reduced transparency. With that in mind, Thomas goes on to say:
“Clinical services around pharmaceuticals are becoming as or even more important than formulary management” and “(p)roper protocols around pre-authorization and management of drug utilization is critical to managing these costs.”
Thomas closes by saying:
“This is giving rise to a number of independent vendors serving this market who are providing a very differentiated value proposition to employers.”
Thank you Brian! We agree that clinical services around pharmaceuticals are a critical aspect of addressing costs, however, they are also critical to improving the patient and provider experience as it relates to the exhausting world of prior authorizations. Prior authorizations were created to ensure that patients step-through less expensive medication options before getting to more expensive alternatives. Like many rules with good intentions, they have morphed into a labyrinthine path creating complexity for providers and barriers to patients.
Imagine what might happen if medical providers were involved in developing the employer’s formulary, knew the costs of the medications, and were engaged in managing the overall pharma spend? In the world of employer sponsored direct primary care, the scenario above is possible. A provider in an employer-sponsored onsite or nearsite health center, armed with the tools above, could more effectively help patients navigate drug regimens with an eye toward cost AND efficacy.
The potential benefits are numerous:
- Putting the therapeutic and cost decision closer to the patient could eliminate the prior authorization process, its waste, and associated fees.
- Providers and patients would be happier with less complexity and streamlined processes.
- Patient adherence to their therapy and compliance with the employer’s formulary would increase.
- The employer could take an active role in formulary overrides, thereby removing barriers to necessary medications and providing visibility on override impacts to finances.
- Patients needing expensive and complex therapies could be enrolled in health management programs to evaluate ongoing drug adherence and effectiveness while enabling faster response to prudent clinical adjustments.
Employer-sponsored onsite or nearsite health centers are perfectly positioned to offer powerful medical and pharmaceutical interventions. With the right partner, direct primary care providers can bring High Impact Rx to their employer clients.
To learn more contact us at info@nwpharma.com or message us below:
