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Strategic Partnership and  Procurement Services 

There are three large vertically integrated PBMs that account for 80% of total equivalent prescription claims – CVS Health (Caremark), Cigna (Evernorth, Express Scripts) and UnitedHealth (OptumRx) (REFERENCE IS www.DrugChannels.net on April 5, 2022).  Beyond that top group, there are multiple other PBMs, health systems and pharmacy solutions that offer customized, unique and customer-oriented services at competitive pricing.  Further, there are novel partnerships evolving to deliver new care models that are disruptive to traditional insurance carriers.  We will guide you through options based on your strategic plan and then run the process to seek and implement fresh alternatives, taking that work off your plate.  We always begin and end with your goals and objectives.   

  • Pharmacy Program Assessment and Strategic Planning Session 

  • Strategy and Model Solutions Review 

  • Build and Manage Customized RFI or RFP Process 

  • Lead Contracting Phase With New Vendor 

  • New Vendor and Model Implementation 

  • Performance Assessment 

  • Ongoing Program Health Checkpoints 

Specialty and High Cost Medication Services 

High cost specialty drug approvals in the U.S accounted for 75% of all drug approvals by the FDA in 2021 and this trend will continue in 2022 and beyond.  Of these, 20 cell and gene therapies are projected to be approved by 2025 and more than 500 gene and cell therapies are in the development pipeline.  While some industry experts say these treatments could transform medicine by curing diseases, we know there is still no industry blueprint for supply and delivery, administration and evaluation, and paying for these complex, more personalized treatments.   

 

We are clinicians and business advisors.... we are the right team to put to work for you our clinical expertise and knowledge across the specialty drug supply chain including gene and cell treatments so you don’t have to worry about how to handle these new complex and very expensive treatments.   

Pharmacy Specialty Drug Strategies:  

  • Review current strategies for high-cost medications across pharmacy and medical benefit and determine alternative approaches and assistance for cost savings and clinical management programs. 

  • Assessment of a full specialty pharmacy program around the following areas:  

    • Waste management

    • New to market specialty medication policies 

    • Access to needed medications

  • Funding resource services 

  • Risk management services  

  • Clinical advocates/ navigators 

Medical Specialty Drug Strategies:  

  • ​Review current strategies for high-cost medications under the medical benefit (J codes) and determine alternative approaches and assistance for cost savings and clinical management programs.   

  • Assessment of a full medical specialty carve out program along with the following areas:  

    • Determine optimal site of care 

    • Access to needed medications

    • Post service, prepayment claim reviews  

  • Funding resource services

  • Risk management services

  • Clinical Advocates/Navigators 

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