As a point of innovation, there are health plans that increasingly look to leverage pharmacists within the continuum of care. These trusted health care professionals are one of the most accessible medical resources in communities as many members see them monthly when they pick up their prescriptions. That creates a unique opportunity to enable those providers to help improve the care of members in the community setting.
“From a health plan perspective, a close partnership with various kinds of pharmacies is essential to getting members the medications that they need, when they need them, and at a cost that is most affordable,” says Corey DeLuca, VP of Clinical and Specialty Pharmacy Services at Highmark Inc. “So, when thinking through that relationship, it’s important for health plans to partner with a variety of pharmacies to offer that more holistic network management approach to getting members the medications that they need.”
Smart Business spoke with DeLuca about pharmacy innovation and how it benefits health plan sponsors and their users.
How does leveraging pharmacy innovation save money for employer sponsors?
A health plan’s relationship with pharmacies is essential for members as it ensures they get access to quality, affordable medication therapy. So, it’s important that health plans build out that robust pharmacy network offering to make sure that users can manage their care. It’s not a one-size-fits-all approach. Ideally, a health plan would provide access to pharmacies that can serve members across that care continuum — from less complicated conditions to very rare specialty conditions where there may only be a few select medications available for treatment. It requires a robust network offering focused on different pharmacy providers to ensure access and to provide the most cost-effective care for members.
Further, some health plans have begun to think differently about their role in the pharmacy supply chain and how they can influence it at the very beginning of the process to ultimately produce needed therapy at a lower cost and pass that value directly back to the end users. These health plans are driving innovation by working with nonprofit generic drug manufacturers to produce more affordable generic medications for members. It’s a partnership that aligns pharmacies across the country to ensure that the value of these medication therapies is passed directly back to members.
What should employers ask to determine if a health plan is leveraging pharmacy innovation?
When choosing a health plan, employers should ask how the plan is evolving the way it’s offering traditional and specialty medication programs to its members, with the aim of providing access to appropriate and cost-effective therapies for members throughout their health care journey. But also, employers should try to determine if the health plan has a strategy to manage members’ conditions and their medication needs across both prescription drugs and medical benefits. That means having an integrated approach to managing members’ care on the medical side through access to providers, procedures and drugs covered under the medical benefit, and managing the prescription drug needs of the member through the pharmacy benefit. Having integrated medical and pharmacy benefit coverage under one health plan provider results in a more seamless experience for the member and helps to improve outcomes because the plan can see the complete picture of a member’s health experience and deploy comprehensive and personalized care management to best support their health and well-being. That also lowers costs for not only the members, but also group users by having that integrated medical and pharmacy benefit under one health plan provider.
The pharmacy supply chain is complicated, but there is a lot of opportunity for innovation. Health plans, as well as other organizations, are finding ways to create more transparency, with the end goal to make pharmaceutical care more accessible and affordable for members and group customers.
Employers should look for a health plan that’s thinking differently and working to remove some of that complexity from the system to drive better health outcomes and greater value for customers. ●
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