Ask the Expert: What’s A Good Pharmacy Network Strategy?
Pharmacy networks are probably not something that plan sponsors think about every day. Pharmacy networks are like insurance: plan sponsors know they need them, and, sometimes, it may even be time for a change. Here are some of the top questions Express Scripts hears from plan sponsors about pharmacy networks (and some they might be afraid to ask):
What are pharmacy networks?
Pharmacy networks are lists of pharmacies that a specific plan contracts with to provide medication and care at a discounted price. Networks are set up to help members save money, and can be any size. They can also include large retail shops, small, local mom a pop shops, and everything in between, such as mid-sized regional chains.
How do pharmacies get into a network, or not?
In order for pharmacies to be a part of a network strategy, they have to meet certain industry standards that all pharmacy benefit managers (PBM), like Express Scripts, require, such as member safety, meeting government agency requirements, and providing best-in-class patient care. Prospective network pharmacies complete initial credentialing as well as re-credentialing at a minimum of every three years. Last, once credentialing is complete, the pharmacy has to agree to a contracted dispensing rate that might also be tied to member outcomes.
How do plan sponsors know if they have the right network?
Just like networks for seeing a doctor, pharmacy networks are no different. In order to achieve optimal plan and member savings, staying in network to fill prescriptions is key. What’s important to consider is having the right coverage of pharmacies. Factors to consider when deciding coverage should be: population size, geographic area, financial and clinical goals, and medication fills or utilization patterns. A network strategy should be customized to fit the plan sponsor and patient needs.
Does the network really have that big of an impact on the plan?
A well-designed network strategy can be more than just a list of in- and out-of-network pharmacies. When thinking about an optimal pharmacy network strategy for a plan, plan sponsors may want to consider these key elements:
- 90-day supply: These are used for maintenance medications, for members who have chronic, or long-term, conditions and need to take medication regularly. And especially when members can have the supply delivered right to their door, home delivery is as important as ever.
- 30-day, or less, supply: When members need to take medications for a short period of time, such as antibiotics, they need quick access to their acute medications from a nearby pharmacy.
- Clinical and Quality: Member engagement tools for common, costly, and complex disease states can increase clinical outcomes. Also, including a layer of pharmacy care quality measurements can drive even greater member adherence and plan success.
A pharmacy network strategy is a key component to an optimally designed plan, but not just any network design will do. When building out a network strategy, plan sponsors should consider the credibility of the pharmacies included, the savings potential, the size and geographic region of your member population, and the preparedness of the PBM and the pharmacy for both pre-go live and post-go live for a seamless member experience.
Interested in hearing more about how Express Scripts builds networks? Listen to our Encapsulated Podcast.