Most companies renew their healthcare benefits either at the beginning of the calendar year or mid-year, though some other renewal dates are possible depending on the company’s fiscal year and timeline for healthcare benefits. For companies whose pharmacy benefit renewal happens mid-year, now is the time to start planning for that renewal.

Asking some key questions and analyzing your data now can help ensure you’re ready to make any necessary adjustments at renewal time.

Consider what’s ahead for your company

The first step in planning for your mid-year renewal should be to think about what’s ahead for your company overall.

  • Are you anticipating an increase or decrease in your staffing?
  • Do your financial projections show an increase or decrease in revenue or expenses?

With these projections, you can begin to learn how your pharmacy benefit plan may change during the renewal process based upon the needs of your employees and the needs of your business.

Review healthcare spend data

The next step in planning for policy renewal is to review the year-to-date healthcare spend data for your current plan, including pharmacy utilization and spend. During this phase, you will want to consider the structure of your existing prescription benefit plan and any recent utilization changes that would increase cost to specific members and the plan.

This data includes the number of generic and non-generic prescriptions filled in the current benefit year, your year-to-date spend tracking compared to what you had projected, and data about high-cost brand and specialty medication programs. Part of the conversation should be discussing if equally effective lower cost medications could be utilized to reduce cost to both the member and the plan.

You should also be aware of and understand how your plan’s copays, formulary, rebates, and other components, such as alternate funding of high-cost medications, impact the plan and overall cost. You may consider involving your management team or all employees in this process so you can assess how well the plan is working for them.

As prescription drug prices continue to rise, it is helpful to have a PBM that works on your behalf to make sure your employees achieve the best overall outcomes at the lowest possible cost.

Identify cost control opportunities

As the final part of planning for your mid-year pharmacy benefit renewal, we recommend identifying any areas where there may be an opportunity to reduce costs or expand coverage for employees. This is especially true for specialty medications, which are a small percentage of usage but a significant cost for many plans. MaxCare has multiple solutions that have helped our customers reduce their pharmacy costs despite the increasing cost of prescription medications.

Discuss options with your pharmacy benefits manager

As you navigate the planning process for your mid-year pharmacy benefit renewal, don’t be afraid to ask us for help. As your pharmacy benefit manager, we are always here to answer your questions about what plan adjustments may reduce your costs while still providing valuable benefits to your employees.

MaxCare focuses on collaboration and communication with our clients. We believe in true transparency every step of the way, and we’ll help review all your current data and make recommendations for any plan changes that may be helpful during your renewal based on utilization and potential cost savings for both the member and the plan.

Let’s prepare for your pharmacy benefit renewal together. Contact us today!