Why do Pharmacy Analytics matter?

Cost 
  • Pharmacy represents 25% of total medical spend in 2022 and continues to outpace healthcare trend
  • 2% of the population uses a specialty medication accounting for over 50% of the total cost
  • Specialty drug trend is increasing 10-15% per year
​​Visibility
  • Pharmacy is the most used healthcare benefit (#1)
  • Direct to consumer advertising drives up utilization
  • Continuous legislation and media attention
Complexity 
  • Advances in technology and genomics will accelerate drug development, approval and distribution
  • Contract terms are confusing, opaque and not client centric
  • Multiple vendors and flows of money, goods and services are complex

Introduction to PBM Challenges

Part 2 - Solutions & Case Studies

Recommended PBM management best practices 

PictureRyan Czado, PharmD presenting at NEEBC's Rx trends forum
  • Engage in benchmarking, marketing and ongoing audits with your broker, consultant or independent 3rd party such as Lockton
  • Use consultants whose team includes pharmacists and clinicians with first-hand PBM knowledge and experience 
  • ​Standardize all definitions, performance guarantees, calculations and terms to best industry practices
  • Collect and analyze all of the data and information that affect the plan-sponsor cost and risk
  • Require bidders to consent to consistent and auditable, dollar-for-dollar performance guarantees that are independently reconciled
  • Require individually reconciled minimum discount and rebate guarantees on a dollar-for-dollar basis
  • Perform a rigorous financial valuation and comparison of markets
  • Engage in competitive contracting before binding coverage
  • Ongoing clinical programs analysis
  • Ongoing financial performance audits including
  1. Ensure PBM performance is consistent with guarantees and claims adjudication follows contract terms
  2. Penalty payments are collected and passed on to plan sponsors when the PBM performance falls short of the contractual guarantees

Why Lockton?

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Lockton is a leading-edge expert with the resources to manage your pharmacy program effectively, contain cost, improve employee well-being and be accountable for the results. We are the next generation; we are the solution.

We’re the fair and impartial mediator between health plans, self-funded employers, TPAs and other payers and their PBM firms.

We help:
  • Optimize the pharmacy benefit management (PBM) marketplace;
  • Leverage improved PBM and vendor arrangements;
  • Identify additional opportunities for cost savings;
  • Develop sound strategies that will keep pace with the dynamic marketplace.

​Specializing in creating and managing:
  • Customized medication management solutions;
  • Outpatient PBM programs;
  • Medical pharmacy (physician-administered) medications solutions.

Lockton Pharmacy Newsletters 
​Clicks links below

Second Quarter 2022
  • Humira Savings on the Horizon?
  • Are Limited Distribution Drugs Limiting Your Savings?
  • The Affordable Insulin Now Act
First Quarter 2022
  • Some Good News Due to Upcoming Generics
  • Industry Titans Make a Media Splash with Low-Cost Drug Approaches
  • To Bag or Buy - That is the Question
Fourth Quarter 2021
  • Medication Adherence: Is is a Waste of Money?
  • Shifting Focus: From COVID Vaccines to Easily Accessible Treatments
  • Value Based Contracting is Starting to Evolve with Pfizer's New Warranty Program for Oral Cancer Therapy Xalkori
Third Quarter 2021 
  • Diabetes: What's Driving Non-Specialty Trend?
  • Gene Therapies: Looking Back and Looking Ahead
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Curious about this rapidly evolving market and Lockton's approach?  Please reach out to mmsmith@lockton.com
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