Pharmacy Benefit Management Solutions
Your Prescription for Managing Pharmacy Benefits
With total U.S. spending on health care projected to grow by $1.4 trillion—from $3.6 trillion in 2018 to $5.0 trillion in 2024—employers are constantly grappling with how to lower costs while improving employee health and access to care. The numbers are staggering, and pharmacy costs represent almost 80% of all health care transactions. A laser-like focus on managing these benefits is critical to ensure they are being utilized appropriately and wisely—both to help your employees improve and maintain their health—and to mitigate their impact on your bottom line.
Through partnerships with leading pharmacy benefits management consulting firms, KBS RxM manages cost, ensures superior client and member service, and delivers comprehensive decision support for your organization’s pharmacy benefits. Offering a close look into pharmacy costs, drivers and trends as well as ongoing strategies and risk management services, KBS RxM provides:
- Innovative cost savings programs
- Strategic financial modeling and reporting
- State-of-the-art clinical management services (through PBM)
- Comprehensive financial and operational compliance audits through pharmacy procurement vendor
KBS RxM conducts a thorough audit of your pharmacy program and vendors.
- Plan Design
- PBM Formulary Management
- Pharmacy Benefit Management (PBM) Contract Compliance
- Clinical Prior Authorization
- Fraud, Waste and Abuse Mitigation
In conjunction with our external consultants, KBS RxM engages with your selected PBM to ensure that your members get the right drug at the right time. As offered and administered by the selected PBM, services include:
- Concurrent Drug Utilization Review
- Specialty Medication Step Therapy
- Opioid Management
- Oncology Management
- Medical/Pharmacy Management
KBS RxM establishes annual strategic plans for your pharmacy benefit program. Once the plan is established, KBS RxM provides a close look into pharmacy costs, drivers and trends as well as ongoing strategies and risk management services. KBS RxM offers:
- 12 months of Current Pharmacy Claims
- PBM Contract Compared to Proprietary Contracts of Four National PBMs
- Year-End Contractual Review
- Actual Performance vs. Discount Guarantee
- Over-the-Counter (OTC) Step Therapy Programs evaluate, implement and model the return on investment for any OTC program that may be advantageous for your plan and your members.
- Retail Generic Programs recommend plan designs that increase members’ use of special discounts by retailers and networks.
- Patient Assistance Programs identify the high-cost drugs being used by your members, then contact drug manufacturers who have copayment assistance and subsidy programs to see if patients qualify.
*Provided in partnership with a pharmacy procurement vendor
KBS RxM’s audits and daily oversight not only save between 9-15% of your annual drug spend, they verify that the rest of your annual drug cost is being properly administered and adjudicated by your PBM.
Real Stories of Real Savings
See how KBS RxM has helped organizations of all sizes achieve tangible success.
Industry: Municipality
Location: Baltimore, Maryland
Employees: 10,000 on plan
Result: Stayed with incumbent PBM, moved to preferred contract and achieved 26% savings
Three-Year Savings Projection: $27.2 million
Industry: Non-Profit
Location: Colorado Springs, Colorado
Employees: 2,200 on plan
Result: Changed PBM and achieved 28% savings
Three-Year Savings Projection: $2.5 million
Industry: Manufacturing
Location: Philadelphia, Pennsylvania
Employees: 2,000 on plan
Result: Stayed with incumbent PBM, moved to preferred contract and achieved 19% savings
Three-Year Savings Projection: $2.4 million
Industry: Health Care
Location: Baltimore, Maryland
Employees: 1,050 on plan
Result: Stayed with incumbent PBM, moved to preferred contract and achieved 21% savings
Three-Year Savings Projection: $1.8 million
Industry: Non-Profit/Finance
Location: Columbia, Maryland
Employees: 615 on plan
Result: Stayed with incumbent PBM, moved to preferred contract and achieved 26% savings
Three-Year Savings Projection: $1.7 million
Industry: Construction and Real Estate
Location: Washington, D.C.
Employees: 1,400 on plan
Result: Stayed with incumbent PBM, moved to preferred contract and achieved 16% savings
Three-Year Savings Projection: $1.2 million
Industry: Hospitality
Location: Wilmington, Delaware
Employees: 300 on plan
Result: Changed PBM and achieved 40% savings
Three-Year Savings Projection: $400,000