How Clinical Services Can Reduce Costs for Prescription Benefits

Providing quality healthcare benefits is an important part of recruiting and retaining the talent you need in your organization. With prescriptions costs representing a significant part of total healthcare spend, there are some key strategies to help reduce costs while still taking care of your employees.

We have a dedicated clinical services team whose mission is to save the plan holder money while better serving its members. They work on behalf of our customers to help control pharmacy costs in three effective ways.

Watching for high-cost combination drugs

Sometimes, two medications are prescribed in combination to treat a patient’s condition. When this happens regularly, a drug manufacturer may decide to package those two medications as a combination drug because it seems easier for the doctor, pharmacy, and patient to have one prescription instead of two.

However, these combination drugs are sometimes more expensive than if the two drugs were purchased separately. It’s not always apparent to the patient or insurance company when this happens, but our SmartBlock program helps us identify these instances.

When we identify that the individual medications would be less expensive if prescribed separately, we recommend an adjusted prescription to reduce costs. Additionally, sometimes compounded drugs are available directly from the pharmacy to replace the combination drug from the manufacturer.

Recommending lower-cost drugs

As your PBM, we help plan holders and plan members control costs with a regularly reviewed drug formulary. While it is always our priority for your plan members to receive the medications and care they need, we also aim to help our customers control costs. Creating a comprehensive and inclusive drug formulary fulfills both needs.

The preferred drugs in the formulary are less expensive yet clinically proven to be equally effective. Members will have lower out-of-pocket expenses when receiving medications on the preferred list. Non-preferred options may still be available, though with a higher copay amount.

This system allows us to provide a quality pharmacy benefit plan while helping control costs by recommending lower-cost alternatives when possible.

Managing specialty medications

With any pharmacy benefit plan, you likely will have members who need high-cost specialty medications. We help ensure the high-cost drug is the right medication for the patient and work with them directly to ensure the medication is taken as prescribed for better outcomes.

In some cases, the specialty drug may be the only option to help the plan member. In those cases, one way to help mitigate the cost to your plan is to connect employees to an assistance program offered by the drug manufacturer. When available and eligible, these programs can help reduce the total cost to the patient and the plan.

Learn more about the MaxCare difference

As a transparent PBM who works with your best interest in mind, we are ready to help you take control of your healthcare costs. We work with you to create the perfect plan to meet your needs and budget while offering transparency, accountability, and customer service.

We’d love to talk to you about the MaxCare difference. Contact us to learn more.

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