Controlling Costs Through Pharmacy: Your Guide to Pharmacy Benefits

Controlling Costs Through Pharmacy: Your Guide to Pharmacy Benefits

As healthcare spend and prescription medication costs continue to rise, pharmacy remains a significant untapped opportunity for self-funded employers to save on benefits. However, traditional PBM management approaches to pharmacy benefits are both flawed and insufficient to navigate market dynamics like rising costs, new treatment options and the demand for transparency. Now is the time to start planning to ensure all pharmacy benefit plans can benefit from the right analysis and contract negotiation, with plenty of time for implementation for upcoming plan renewals.

One way to start is by abiding by the three pillars of pharmacy benefit strategy. We’ll discuss further insights and options in this webinar.

Pharmacy Benefit Management Trends Heading In 2024 and Beyond

Higher pharmacy spend today is largely a result of the rising cost of specialty drugs and their increased utilization. With only 2% of claims, specialty drugs now consume 55% of drug expenditures. The emergence of biosimilars is beginning to help with controlling costs, but the effects they’re having the market are too gradual for most self-funded plans to feel the relief they need.

Trending strategies for maximizing pharmacy spend have arisen to help plan sponsors compete against the drive for PBM profits, including:

• Discounts and rebates in exchange for higher flat fees (AKA “pass-through” offerings)
• A reduction in copayment-assistance programs. Many were compromised by copay accumulators and maximizers.
• A la carte, unbundled pharmacy services that depart from the traditional full-service PBM model (alternative funding, specialty carve-outs, etc.)

These strategies and others are helping to create pharmacy benefit savings through smarter plans, transparency, and greater payer control.

During This Webinar, We Share Insights About:

• Current trends in pharmacy benefits and Pharmacy Benefit Manager relationships
• Key players and considerations for developing your pharmacy strategy
• Best practices and case examples we’ve seen in the market

The session also addressed several audience-submitted questions, covering topics like gene therapy, Ozempic, and specialty carve-out.

About the speakers:

Sara Sherrod

As the Vice President of Marketplace Management at Truveris, Sara leads the team responsible for connecting PBMs and pharmacy vendors with plan sponsors on the Truveris Marketplace. In this way, Sara has deep domain expertise on the many variables that pertain to PBM contracting, pricing, and implementation. Her team has helped hundreds of plan sponsors find and procure a tailored blend of pharmacy services for their members.  

Before this role, Sara was Director of Strategy and Innovation at Truveris. She has also spent several years at Phreesia, the leading patient intake system, during which the company experienced significant growth.  

You might recognize Sara from her starring role in last year’s Truveris webinar, “Transparency in Pharmacy: Innovative Strategies to Drive Outcomes for Self-Funded Plans.” 

Ryan Storey

As Vice President of Pharmacy Solutions and Strategic Accounts, Ryan provides context, insights, and recommendations for maximizing pharmacy benefits at Truveris.

An experienced pharmacist and consultant with 15+ years working in pharmacy benefits, Ryan previously served as senior pharmacy benefits consultant at two of the largest US consulting firms, optimizing pharmacy benefit offerings via formulary and plan design evaluation, contract negotiation, and specialty pharmacy management. He’s also worked with OptumRx providing clinical consultation, benefit coding, and utilization management evaluation across multiple lines of business.