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.
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Pharmacy Program Assessment and Strategic Planning Session
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Strategy and Model Solutions Review
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Build and Manage Customized RFI or RFP Process
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Lead Contracting Phase With New Vendor
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New Vendor and Model Implementation
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Performance Assessment
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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:
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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.
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Assessment of a full specialty pharmacy program around the following areas:
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Waste management
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New to market specialty medication policies
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Access to needed medications
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Funding resource services
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Risk management services
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Clinical advocates/ navigators
Medical Specialty Drug Strategies:
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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.
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Assessment of a full medical specialty carve out program along with the following areas:
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Determine optimal site of care
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Access to needed medications
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Post service, prepayment claim reviews
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Funding resource services
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Risk management services
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Clinical Advocates/Navigators
Staff Augmentation Services
As industry veterans, we have a strong web of connections to Managed Care and PBM Pharmacists that are available for contracted roles to enable/supplement your clinical services such as:
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Prior Authorization Services
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Concierge Pharmacist to support customer service requests that are clinical in nature
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Medication Therapy Management Services
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Utilization Management Services
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High Cost Case Reviews
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Clinical Policy Development
We specialize in building customized teams to fit your requirements and deliver the quality results you expect. We also ardently provide mentoring and development of pharmacists earlier on in their careers that desire to be a part of shifting the industry to a more transparent place and are dedicated to compassionate and high-touch member care.
Growth and Customer-Centric Strategy and Execution Services for Healthcare Companies
We’ve built, grown, turned around and managed multiple sales/account management teams in the pharmacy space. And we believe that working with prospects and current customers is part art and part science. Strong relationships are critical and to succeed, business processes that are repeatable must exist.
Growth and customer retention are mission critical to any organization; we will bring best practices tailored to health and pharmacy service offerings in the following categories:
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Strategic Planning
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Building Strong Organization and Culture
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Capturing New Business
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Managing and renewing your business: assuring customer satisfaction, retention and growth