I love helping cash-strapped community and governmental organizations do more with their money.
That’s what we were able to do for Waupaca County in the beautiful chain of lakes area of Wisconsin.
Waupaca County has a long track record of investing in employee health. But rapid increases in the cost of pharmacy benefits were straining their budget.
In 2019, they brought on Robin with HealthPartners as a new carrier to improve the benefits experience for their employees and help control pharmacy benefit costs, saving them $240,000.
That’s where our team of pharmacists and I came in.
The way we helped Waupaca County mirrors our tried-and-true process of fine-tuning benefits plans to meet our customers’ goals. Here’s how we do it.
Fine-tuning pharmacy benefits for our partners
We spend days reviewing customers’ pharmacy claims, analyzing both big-picture trends and changes in the use of individual drugs. Key concerns we look at are:
- Utilization (the rate of medication use). Are the number of people using medications increasing?
- Drug mix (the mix of medications being consumed). Are there expensive, blockbuster medicines, like for instance a new cancer medication, in the mix? Are there new-to-market, million-dollar therapies being tried for a rare condition for the first time? Are there opportunities for less expensive alternatives?
- Price (unit cost of medications). Are the medicines used getting more expensive?
Usually we identify lots of cost-reducing opportunities, such as using generics and biosimilars (lower-cost alternatives to specialist drugs for chronic conditions) in place of more expensive products.
Managing all facets of medical and pharmacy benefits as one, without any conflict of interest, lets us see everything under one umbrella.
Opportunities like these would often be hidden to a pharmacy benefit manager (PBM) managing the pharmacy benefit as a carved-out service.
Our detailed pharmacy detective work, coupled with our integrated approach to managing all pharmacy spend, helped save Waupaca County $240,000 – money that can be put to good use.
To learn more about smart pharmacy benefit management and see the metrics that matter, read HealthPartners Pharmacy Benefit Management Case Study.