How Can Pharmacy Benefit Tools Save Money for Insured Patients?

Jon Gavras, MD, chief medical officer at Prime Therapeutics, analyzes the benefits of pharmacy benefit tools for patients with private and public insurance.

Gavras: The pharmacy benefit is a very strong tool in managing overall cost. As I mentioned earlier, there is both a significant medical component and pharmacy component to how members receive that drug.

How you craft that benefit so that they will go through a channel that is not only easier for them to access but also less expensive for them is very important.

The management of formulary for the most preferred drugs from an outcomes standpoint, cost standpoint, and the fact of the relationship you can develop with the manufacturer is key to really getting folks the highest value they can while they’re on a medication. Most specialty medications are expensive, therefore, it’s important to manage the formulary.

In addition, it’s very important to manage the network. With our partnership with Walgreens— with the new AllianceRx for specialty medications—we’ve been able to demonstrate that by more narrower networks that give very broad access, we’ve been able to save a significant amount of money for our members last year. Going forward, it will be close to a billion dollars next year by utilizing these more narrower networks.