With drug costs continually escalating, health plans need to capture every available dollar to reduce their overall healthcare expenditures. One way to realize value is through medical drug rebate dollars. Due to continued expansion of biosimilars and other market pressures, pharmaceutical manufacturers of drugs administered and covered under the medical benefit are offering substantial rebates to health plans—returns that are often left on the table.
Medical drugs are usually administered in a clinical setting, such as a hospital’s outpatient clinic or a physician’s office. These complex drugs treat conditions such as chronic inflammatory diseases or multiple sclerosis, and they have traditionally offered little return to the health plan. But as pharmaceutical rebate contracts have increased over the years, they have provided expanded opportunities for health plans to save on their medical drugs.
Strategize your savings
As a managed care organization, you want the lowest net cost for each drug prescribed for your members. Savings strategies may include covering a clinically-equivalent biosimilar or taking a rebate on a target drug.
Medical drug rebate administrators can help you determine the best strategy for reducing your medical claim liability to achieve the lowest net drug cost. While many PBMs offer this service to their health plan clients, you may want to consider using a separate provider. There are many vendors who specialize in medical benefits management.
Whether you go with your PBM or choose a separate vendor, your medical drug rebate administrator has the tools to help you manage your medical spend and reduce your claim liability. You can take advantage of flexible service models that align manufacturer contracts with your plan’s clinical criteria for drug authorization.
Are you leaving money on the table?
Drug cost management is always a top priority for managed-care organizations. You need the freedom to choose the strategy that will deliver the most savings and the best clinical outcomes for you and your plan members. That may mean expanding the relationship with your PBM vendor, or it may mean choosing a separate administrator for medical benefits management.
PSG can help you navigate the complexities of the medical rebate market, determine the right service model that best fits your health plan, and get on the path to optimal savings.
Don’t let another savings opportunity pass you by! Contact us for a complimentary consultation to dive deeper into uncovering medical rebate opportunities.