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Tips and trends to unlock pharmacy and medical savings.
Drug Rebates: Impact on Self-Insured Employer Plans
Team PCM
October 24, 2023
Drug rebates refer to financial agreements between pharmaceutical manufacturers and payers, such as self-insured employer plans or pharmacy benefit managers...
Prescription Cost Management Best Practices: PBM Contract Market Check
Team PCM
September 8, 2023
Benefits consultants face significant challenges when managing pharmacy benefit spend for clients. The lengthy process of evaluating Pharmacy Benefit Management...
Navigating the Complex Landscape of Self-Insured Plans: Overcoming Data Challenges
Team PCM
August 15, 2023
In the ever-evolving healthcare landscape, benefits brokers, consultants, and TPAs face the daunting task of making critical decisions that impact...
Drug Discounts: How They Affect Plan Sponsors
Team PCM
July 19, 2023
Drug discounts are reductions in the cost of prescription medications as negotiated by pharmaceutical manufacturers and Pharmacy Benefit Managers (PBMs)....
Including Annual Market Check Provisions in Pharmacy Benefit Contracts
Team PCM
June 19, 2023
In the ever-evolving healthcare landscape, pharmacy benefits are crucial in ensuring affordable medication access for patients and plans. Pharmacy benefits...
Navigating Drug Shortages: How Employer-Sponsored Health Plans Support Participants
Team PCM
May 23, 2023
Drug shortages are at a ten-year high, challenging patients and healthcare providers. These shortages occur when the demand for a particular...
5 Key Metrics to Evaluate Pharmacy Contract Performance
Team PCM
April 14, 2023
Five Metrics to Evaluate Pharmacy Contract Performance Brokers can evaluate pharmacy contract performance by monitoring several key performance indicators (KPIs)...
Drug Exclusions are Affecting Patients and Plans
Team PCM
March 21, 2023
The 2023 growth may be small, but drug exclusion lists are still growing for the three largest pharmacy benefit managers...
Benefit Broker Resolution: Avoid Burnout
Team PCM
January 23, 2023
Like the rest of American workers, pharmacy benefit brokers are burning out. Rising healthcare and drug costs, ever-changing policies, and...
Save by Switching from High-Cost Generics
Team PCM
January 6, 2023
Switching from an expensive brand-name medication to a lower-cost generic alternative is a proven savings strategy self-insured plan sponsors employ...
Drug Pricing and the Inflation Reduction Act
Team PCM
October 24, 2022
The passage of the Inflation Reduction Act (IRA) in August 2022 will impact patients, providers, and benefit plan sponsors by...
Interchangeable Biosimilars: Plan and Patient Savings
Team PCM
September 14, 2022
Biosimilar drugs are “highly similar to” and have “no clinically meaningful differences” from existing FDA-approved biologics. Currently, there are 38...
Lowering Diabetes Medication Costs with Alternative Strategies
Team PCM
July 21, 2022
One in ten people in the United States has diabetes. $1 in $4 of US healthcare costs is spent caring...
Medical Pharmacy Affects Plan Spend
Team PCM
June 28, 2022
Pharmacy costs get all the press for rising prices; however, brokers and plan sponsors need to consider medical pharmacy if...
RFP Questions You Should be Asking
Team PCM
May 24, 2022
When evaluating a PBM contract at renewal or mid-term market check, brokers and plan sponsors should be asking questions. Questions...
Validating Pharmacy Savings Programs
Team PCM
March 24, 2022
Americans spent $328 billion on prescription drugs in 2020, eight percent of total healthcare spend. The rising cost of medications...
Navigating Gene Therapies
Team PCM
February 24, 2022
Research on gene-therapies began in 1960 with the hypothesis that introducing DNA sequences into patients' cells could cure genetic disorders....
A Primer on J Codes
Team PCM
January 18, 2022
High-cost prescription drugs have been wreaking havoc on pharmacy plan budgets for over a decade. However, did you know that...
Trends to Follow in 2022
Team PCM
December 16, 2021
This year saw a post-pandemic return to preventive care, the introduction of several biosimilars, and legislation governing healthcare transparency. However,...
Data and Vendor Fragmentation in Health Benefits
Team PCM
October 25, 2021
As payors and stakeholders move to more plan-centric health benefits models, fragmentation significantly impedes program efficacy. Point programs added to...
Artificial Intelligence in Pharmacy: Improving Patient Outcomes
Team PCM
September 10, 2021
Artificial Intelligence (AI) in pharmacy refers to automated algorithms that perform tasks traditionally completed by human intelligence. 62% of healthcare...
Covering Specialty Drugs: Medical vs. Pharmacy Channel
Team PCM
August 18, 2021
For self-insured plan sponsors, specialty drugs represent 33-50% of total pharmacy spend but only account for 1% of total prescription...
Drug Rebates Affect Formulary Management
Team PCM
June 14, 2021
Formulary management is becoming increasingly important for plan sponsors. As drug prices, especially specialty costs, continue to rise, improving participant...
A Primer on Biosimilars
Team PCM
May 12, 2021
It has been 15 years since the widespread adoption of biosimilar medications in the European Union. Ten years later, in...
Improving Medication Adherence
Team PCM
April 15, 2021
Medication adherence is a longstanding issue within the complex American healthcare system. Made worse by the global pandemic, nonadherence to...
Three Plan Metrics Every Employer Should Be Monitoring
Team PCM
March 17, 2021
60% of employers report that the cost of their current pharmacy plan is unsustainable. Without requesting bids from vendors or...
Achieve Lowest Net Cost with Clinically Driven Formulary
Team PCM
February 17, 2021
Clinically driven models are creating a buzz across healthcare. A clinically-driven model moves from a volume-based revenue system to a...
Pharmacy: Looking forward to 2021
Team PCM
December 15, 2020
This year has been, in a word, unique. Fortunately, time marches on, and a new year is around the corner....
Transparency Brings Balance to Drug Rebates
Team PCM
November 17, 2020
There are six significant stakeholders in the complex drug distribution system: pharmaceutical manufacturer, plan sponsor, pharmacy, PBM, wholesaler, and patient....
Specialty Drugs: What are they and what (or who) controls costs?
Team PCM
October 9, 2020
The cost of prescription medications is rising, but one sub-set of drugs may be disproportionately eating away at financial resources....
Pharmacy Analytics: How to Lead with Data
Team PCM
August 5, 2020
Experts have long predicted the demise of the spreadsheet; information silos, slow turnaround, and incomplete reporting replaced by AI and...
COVID-19 Treatment: Where Are We?
Team PCM
June 22, 2020
As some states lift stay-at-home orders amid growing numbers of COVID-19 cases, scientists worldwide are working on potential treatments and...
Another COVID-19 side effect: Drug shortages
Team PCM
May 6, 2020
Even before COVID-19 wreaked havoc on the United States’ healthcare system, the availability and price of prescription drugs were a...
Creating emergency medication reserves
Team PCM
March 31, 2020
The severe state of emergency facing our global community has resulted in many of us staying home in a united...
Database searches and spreadsheets are not analytics
Team PCM
February 28, 2020
If you rely on spreadsheets, SQL, or your data team to generate pharmacy plan reports, you are wasting time and...
Who determines drug prices?
Team PCM
January 14, 2020
Along with fireworks, champagne, and resolutions, we rang in 2020 with price increases on hundreds of drugs. New year, same...
Part 2: What is your pharmacy strategy for 2020?
Team PCM
November 13, 2019
Last month we gave you two strategies, carefully developed by our pharmacy team, that can help you craft a solid...
Part 1: What is your pharmacy strategy for 2020?
Team PCM
October 11, 2019
Another year has nearly passed with little change in how the pharmacy industry operates. Pharmaceutical companies are still raising drug...
Harness pharmacy data to make better decisions
Team PCM
September 9, 2019
Can your broker, benefits department or PBM tell you how your pharmacy dollars are being spent? Are they able to...
Why you should engage doctors to save on drugs
Team PCM
August 5, 2019
Drug prices are bankrupting employers. This isn’t new. A lack of transparency, fuzzy math and back-door deals have overwhelmed the...
Data Analytics: 3 Keys to a Powerful Savings Tool
Team PCM
July 15, 2019
Our dynamic healthcare system is full of “big data” from the information, statistics, and trends of participants, physicians, plans, and...
How Are Your Pharmacy Dollars Being Spent?
Team PCM
June 10, 2019
Everyone is talking about pharmaceutical costs. We all know that prescription drugs are becoming unaffordable for many patients and plans,...
Your Members Need the Right Drug at the Right Dose
Team PCM
January 21, 2019
Thirty-two million Americans are taking three or more prescription drugs. Of those, 53% are taking the wrong drug or wrong...
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