How To Build A Hospital-Friendly Pharmacy Benefit

Top 3 Things You’ll Learn

  • Maintaining a rich pharmacy benefit is essential for attracting, retaining, and properly caring for hospital and healthcare workers
  • HR teams need to balance attracting and retaining top talent with the financial constraints of their organizations
  • Traditional PBM models don’t work for most hospitals and health systems

Care and support of hospital and healthcare system employees is essential, and maintaining a rich pharmacy benefit is critical to attracting, retaining, and properly caring for hospital employees. As sophisticated consumers, healthcare workers actively seek out medical services, explore innovative treatments, and judiciously utilize their pharmacy benefits, leveraging their extensive knowledge of healthcare for diagnosis and treatment.

As a Human Resources team member at a hospital or health system, you understand the heavy lift of managing employee costs, leveraging their special pharmacy access resources, and providing a high level of service for both members and pharmacy teams.

Without pharmacy-specific contracts with hospital-friendly transparent pricing, terms, and guarantees, hospital HR teams can struggle to provide rich pharmacy benefits that meet the needs of employees. In a recent hospital-focused webinar conducted by RxBenefits, 76% of attendees identified the need for clear pharmacy-specific contracts as a high priority. The reality is, inflexible contracts are just the beginning when it comes to flaws with the traditional PBM model.

Why Traditional PBM Models Don’t Work for Hospitals and Health Systems

1. Off-the-rack pharmacy models can’t meet the uniquely specific need of hospital and health systems teams. Unlike most plan sponsors, hospitals and health systems have to meet the needs of two distinct groups within their organization.

  • Your HR teams need to be able to offer excellent benefits to attract and retain the best employees while optimizing their benefits within a set budget.
  • The onsite pharmacy needs to generate revenue by filling as many prescriptions as possible while optimizing resources, with the support of a fast-responding service team.

2. The contract’s fine print usually aligns with the PBM’s goals, not yours. PBMs tend to require members to use the PBM’s owned pharmacy or preferred pharmacy, but your goal may be to support an in-house pharmacy. To succeed with federal programs like 340B, hospitals need flexibility and a pharmacy partner with their best interests in mind.

3. Traditional models lack programs and strategies that align with in-house pharmacies. To stay financially viable, an in-house pharmacy needs to fill as many scripts as possible – but it also has to make sure those scripts are filled appropriately. The pharmacy may want the right of first refusal to fill prescriptions, help in raising awareness to drive utilization, and a service team to help resolve issues quickly.

4. Standard models take an unsustainable approach to addressing risks associated with specialty. The fight against rising specialty costs starts with a client-aligned contract that includes aggressive discounts and rebates. It also calls for effective utilization management – appropriate clinical oversight can determine whether a pricey specialty drug is the best option for that member and, if so, that it is being prescribed correctly. You also need to be sure your hospital or health system is making the most of available manufacturer assistance programs, taking advantage of savings in a way that serves both the members and the plan sponsor’s bottom line, and that those programs are being maximized in a way that doesn’t offset member responsibility for any applicable deductible or out-of-pocket obligation.

5. Traditional models often lack transparency. PBM Contracts don’t always provide visibility into terms and details that can make a difference to hospitals and health systems that depend on flexibility and control of their pharmacy benefits.

Find the right partner to tailor your pharmacy plan.

In today’s competitive labor market, a comprehensive pharmacy benefit is essential to attract, retain, and care for hospital and health system employees. Such benefits drive employees to utilize in-house pharmacies, promoting seamless healthcare delivery within the institution. It also allows plan sponsors to cater to their needs as sophisticated healthcare consumers who face unique high-risk and high-cost situations.

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