10 Things to Look for When Choosing a Pharmacy Coalition
Brokers, TPAs and Groups: Selecting the right pharmacy coalition is a critical decision that can significantly impact your organization's pharmacy benefits strategy. Not all coalitions are created equal, and understanding what to look for can make the difference between a beneficial partnership and a missed opportunity.
Key Factors to Consider
1. Guarantees on Pricing and Rebates: Ensure that the coalition offers clear, robust guarantees on pricing and rebates. Look for 100% rebates and transparent terms at the plan sponsor level rather than an aggregate level. This ensures that the benefits you receive are directly correlated to your group’s performance and needs.
2. Comprehensive Contract Terms: Examine the contractual terms in detail. It's crucial to understand the guarantees, pricing structures, and the flexibility of the contract. Ensure that the coalition is committed to continuous improvements and that they perform annual reconciliations to validate compliance with agreed terms.
3. Access to Data and Reporting: Data transparency is vital for effective management. Ensure that the coalition provides detailed reporting, including annual reconciliation reports and ongoing analytics. This access allows you to track performance, identify areas for improvement and make informed decisions.
4. Clinical Support and Management: The rapid evolution of pharmaceuticals (think biosimilars and new, costly meds in the FDA pipeline!) necessitates robust clinical support. A coalition with a strong clinical team can provide guidance on formulary decisions, manage specialty drugs, and ensure that clinical practices align with best outcomes and cost-effectiveness.
5. Flexibility and Customization: Each organization has unique needs, and a one-size-fits-all coalition rarely works. Ensure that the coalition offers customization to meet your specific requirements, whether that involves selecting particular PBMs or implementing specialized cost-containment strategies and programs, including but not limited to specialty carve out, therapeutic interchange, pharmacogenomics and prior authorization oversight.
6. Service and Implementation Support: Moving to a new coalition can be complex. Ensure that the coalition offers comprehensive implementation and account management services. This support should cover every aspect of the transition, from coordinating with TPAs and brokers to managing member communications and ensuring smooth operational shifts.
7. Ability to Private Label: Being able to white-label a coalition could be a game-changer for brokers and TPAs seeking to enhance their market presence and client loyalty without the overhead of developing these capabilities in-house. By adopting a private-label approach, you can market high-value pharmacy services under your own brand, which can significantly increase your competitive edge against larger firms with internal pharmacy solutions.
Evaluating Potential Partners
8. Track Record and Reputation: Research the coalition’s history and reputation in the industry. Look for testimonials and case studies that demonstrate their ability to deliver on promises and support their clients effectively.
9. Alignment with Your Goals: Ensure that the coalition’s goals and values align with yours. They should prioritize cost savings, clinical efficacy, and member satisfaction, just as you do.
10. Support Infrastructure: Assess the coalition’s infrastructure for ongoing support. They should have a dedicated team for analytics, clinical support, and account management, ensuring that you have access to expertise and assistance whenever needed.
When considering your options for a pharmacy coalition, remember that it’s not just about pricing. TPAs, brokers and benefit consultants should look beyond the spreadsheet and consider the whole picture. Evaluate the contract terms, clinical management, and the overall quality of service provided. Ensure that the coalition you choose offers robust tools and support for members, including transparent data, regular reporting, and clinical insights. Finally, verify that the coalition allows for private labeling if that’s something you’d like to consider and that it has mechanisms in place for continuous pricing improvements and annual reconciliations to ensure ongoing value. By focusing on these comprehensive factors, you can select a coalition partner that truly enhances your pharmacy benefits strategy, leading to better outcomes for your clients and their members.
Editor’s Note
CoeoRx/AlignRx is dedicated to providing top-notch pharmacy solutions. Whatever your needs, we offer tailored services to ensure optimal outcomes for you and your clients. Our exceptional pricing and comprehensive support set us apart in the industry, making us the preferred partner for those seeking excellence in pharmacy benefits management.