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Services / Pharmacy Consulting

Pharmacy Consulting

As prescription drug costs rise, you’ll want to understand industry trends, current, and future cost drivers, how prescriptions are managed in your health plan, and what you can do to minimize the increases. With the capability and flexibility to design pharmacy benefits tailored to your needs, we simplify the complex nature of today’s pharmacy benefits landscape. Our consultative approach finds cost-effective solutions and develops innovative strategies, helping ensure you can offer employees affordable access to the medications they need.

ELEVATED EXPERTISE

Consultative guidance, powerful results

Pharmacy benefits are a significant component of total healthcare costs, for both businesses and employees. Gain greater control over your pharmacy spend with our detailed analysis that provides clarity and transparency around cost drivers and opportunities to enhance your program without additional spend. As you navigate a pharmacy benefit landscape in continuous flux, you can rely on our consultative approach, objective guidance, and industry expertise to optimize your pharmacy strategy for cost, quality, and transparency.

Our process and expertise include:

Benchmarking analyses

Performance reviews

Utilization assessments 

Cost reduction strategies

Gathering employee feedback

Implementing pharmacy benefit programs

Monitoring trends and regulations 

STRATEGIC GUIDANCE

Shedding light on your PBM strategy

You’ll have several options to consider when you’re optimizing your pharmacy benefits program. As you weigh the benefits and downsides, we’ll provide guidance around best practices for pharmacy management, tailored to your specific objectives and population needs. Our team begins by examining what type of pharmacy benefit manager (PBM) model is included in your health plan – traditional, passthrough, or a hybrid of both. We’ll also look at whether it makes sense to carve in your PBM into your medical health plan vendor or carve out your pharmacy benefit. After examining your current PBM, we’ll walk you through what it offers, how it aligns with your strategic health goals, and see if it makes the best sense for your organization.

RENEWED APPROACH

Evaluate pharmacy benefits with confidence

Backed by knowledge and experience, our team will provide you with thoughtful guidance and unbiased evaluation of your PBM. Through a distinctive, multi-step approach, gain confidence that your PBM provides value for your health plan and enhances well-being for your employees.

Step 1: Audit your current contract

Our process starts with an assessment of the benefits and services your PBM offers your organization. We’ll examine:

Step 2: Provide transparency around key issues

While PBMs manage prescriptions for drug plans, their practices may raise questions over price transparency and lack of competition. Deciphering models and monitoring the regulatory landscape allows us to validate pricing for the drug coverage in your health plan. Our experts can help shed light on key issues, including:

Step 3: Assess carve-in and carve-out programs

You’ll have the option to carve in or carve out your pharmacy benefit program from your medical benefits. With a carve-in approach, you’ll contract directly with your medical plan vendor for medical and pharmacy benefits. A pharmacy carve-out is when you contract directly with a PBM vendor to administer your pharmacy benefits program. We’ll present you with the benefits and disadvantages of each option, so you make an informed decision regarding your path forward.

Step 4: Explore possible wellness programs

Since the overall health of your employees can also drive down drug utilization, you’ll want to know which solutions your PBM offers that can help ensure employees take their medications as prescribed and minimize waste. We’ll help you examine what protocols and programs your PBM uses to maintain clinical continuity and keep drug costs down.

Step 5: Explore possible overlay programs

Partnering with the right PBM is just one part of the story. With the ever-growing increase in specialty medications, it’s essential to have a strategy to manage rising costs. We’ll help provide you with best-in-class recommendations, overlay partners, and proven strategies to manage this expense all with the goal of improving the member experience and curbing costs.

Step 6: Conduct an RFP for a new PBM

If you’re unsatisfied with your current PBM, we can help you solicit competitive bids for a new PBM. Through a methodical process that defines your goals, expectations, and requirements, we’ll:

THE BALDWIN GROUP INSIGHTS

Stay in the know


Our experts monitor the employee benefits space and compliance updates to provide meaningful insights and help break down what you need to know, potential impacts, and how you should respond. 

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Woman with son on her lap looking at a pill bottle

Open the door to possibilities

When you decide to partner with us, you choose to deliver on your commitment to your employees with solutions as distinctive as they are.