Have You Fully Optimized Your Pharmacy Network?
Optimizing a retail pharmacy network is a lot like shopping around for a new cable provider: when they bundle multiple products together, you will save. A good, bundled network will yield many benefits to the plan and its members.
So what does a valuable network bundle look like? Here are some key characteristics:
- A preferred 30-day retail pharmacy network structure for acute medications such as antibiotics.
- Ability for members to obtain 90-day supplies for longer-term therapies that treat chronic conditions such as diabetes, asthma, or high blood pressure.
- Clinical programs to manage common and costly conditions such as diabetes, cancer, heart-related complications, and more.
- A performance-based means of measuring how pharmacies perform to increase patient engagement and physician consultation, and ensure therapy adherence and patient safety standards were met.
In an unbundled network, there is a lot of unrecognized value left on the table each year -- real money that plan can reinvest into their health benefit to offer additional features or lower premiums. At Express Scripts, the most optimized bundled plans see savings of up to $61.86 per member per year. One plan even saved $1.5 million by turning on all of these network components, and will continue to save on every prescription a member fills.
As for members, by providing additional savings, they are more likely to continue filling prescriptions when needed. This encourages adherence to therapies as prescribed, which means decreased medical expenses down the line for plan sponsors. Additionally, members can save up to $10 per acute medication fill, and up to 29 percent on maintenance medications.
By having the right pharmacy network strategy in place, members can get their medications at a pharmacy that is convenient and affordable to them, which encourages them to adhere to their therapy and results in long-term medical savings for the plan. This strategic network should include conveniently located pharmacies, based on the geographic make-up of the member population, and the option for home delivery. Now, more than ever, a 90-day supply is critical to getting members the medication they need safely from their homes.
While optimizing an existing pharmacy network to achieve bundling can sound disruptive, with the right partner and tools in place, it can be a smooth transition. Members will need the necessary information at their fingertips, such as letters sent to their home and emails, as well as advanced digital tools to easily search for an in-network pharmacy and price a medication. When all of these layers are turned on and are structured to find the most value, Express Scripts has seen minimal switching and disruptions for members. The plan and the member can save – a win-win.
To read more about what an optimized pharmacy network strategy can look like, click here.