Flexibility is a key factor in helping employers take control of their healthcare costs. After all, that is really what self-funded insurance programs are about: offering the employer flexibility to customize their plan and decide what is covered instead of trying to fit them into pre-determined options offered by large healthcare organizations.

Flexibility and customization are key for pharmacy benefits, too. With so much changing in healthcare and costs continuing to increase, self-insured employers deserve a PBM willing to be flexible and help them redesign their benefit plan to control costs and fit their needs.

Adapting to changes

The pharmacy world is constantly changing. Everything from new drugs hitting the market to more generic options being released to new legislation can impact prescription drug costs. While most consumers do not realize it, the market price for medications changes regularly behind the scenes even though their copay remains stable. A pharmacy benefit manager has to be flexible enough to adapt to these changes as they occur to best serve clients and their members.

Exploring the options

There are a lot of different ways to help clients save on their pharmacy costs, and we help our clients understand the various options so they can decide what is best for their plan. We are asked often if we allow specialty carve-out, which means excluding specialty medications from the plan completely and sourcing them through an alternate funding program. In short, yes, we do allow this, but we take a consultative approach and help employers explore all the options available to them. Ultimately, it is their call on what’s included on the plan. We work closely with our clients to explore and explain all options available and assist them with customizing a plan that fits their needs and the needs of their members.

Responding to client needs

When it comes to pharmacy benefits, going with a larger company doesn’t mean you have more options. In many cases, it limits your options to a set of off-the-shelf plan packages that are best for the large PBMs rather than a customized plan that is best for you. It might also limit your ability to participate in your plan design along the way. Customer service is important to us, and we have intentionally created a collaborative team structure that results in quick answers when questions arise.

If you have encountered pushback from your current PBM or a lack of flexibility with your plan, it might be time to find a better fit with a PBM that allows you as the plan sponsor to decide what is best for you and your members. Contact MaxCare today and regain control of your benefit plan.