PRESCRIPTION DRUG COST MANAGEMENT
We offer solutions to preserve your capital and mitigate risks.
Are your health plan and its participants paying too much for prescription drugs? If you don’t know for sure, you may be depleting valuable capital while leaving your company vulnerable to legal jeopardy.
These solutions Optimize spending without compromising quality care:
- Prescription Drug Spend Audit: Our Team will analyze your claims data to identify cost drivers and potential savings.
- Pharmacy Benefit Manager (PBM) RFP: We will conduct an RFP with “Big 3” and independent transparent pass-through PBMs to provide insight into the PBM market and identify opportunities for savings.
- Pass-Through Transparent PBMs: Eliminate PBM “spread pricing” – the largest source of revenue for Big 3 PBMs. Pass-through transparent PBMs generate revenue through fully-disclosed administrative fees and not through spread pricing. Rebates and discounts are passed onto the plan and not retained by the PBM.
- Oversight, Monitoring, and Ongoing Audits: Conducted by an independent pharmacy consultant (for larger groups).
- CAA Rx DC Reporting: Our team will obtain group-specific data from your PBM to file compliance reports and analyze cost drivers within your plan.
How PBMs Make Money
- Spread Pricing: Reimbursing the pharmacy one amount for a medication, charging the plan sponsor a higher price, and keeping the difference.
- Rebates: Rebates are discounts a drug manufacturer gives a PBM in return for the PBM agreeing to cover the drug manufacturer’s product. Usually, only a portion of those rebates are shared with the plan sponsor.
- Administrative Fees: PBMs often charge fees to manufacturers and plan sponsors.
Start With a Governance & Risk Diagnostic
A focused 20-minute conversation will quickly show whether your health plan has the governance,
financial controls, and vendor accountability your organization needs — or where the gaps are.
What you’ll receive:
- A brief review of your current governance structure, pharmacy oversight, and financial monitoring
- A preliminary assessment of risk, waste, or misalignment in your plan design, vendors, and contracts
- Clear next steps to strengthen performance, reduce volatility, and protect your organization
No pressure. No obligations. Just clear visibility into how your plan is being run.
Prefer email? Contact us at info@allypartners.net