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Transparency, alignment of incentives
keys to success in managing Rx plans
In an increasingly complex pharmacy benefits environment, the need for clarity and focus has become paramount for
payers to be able to maximize the value of their offering to employees and members.
At Rite Aid Health Solutions, a model of collaborative consultation has become the foundation for idea generation and
administration for its client base. Rite Aid maintains that developing the appropriate balance of financial disclosure to the
payer and incentive to the member can make the difference between success and failure of any pharmacy program.
"Our philosophy towards conducting business is to provide our clients with absolute financial transparency, so they may
make better informed decisions, and to provide their members with aligned incentives so their decisions are equally as
effective," says Greg Drew, R.Ph., VP and General Manager of the Camp Hill, Pa.-based company. "In addition to our
disclosure of revenues and fees, our flexibility and creativity towards benefit design and the personnel and systems to
implement those designs can make a defined difference in plan costs and trends".
As payers face escalating pharmacy benefit costs and a complex administration environment, they are increasingly
looking for a Pharmacy Benefits Manager to be aligned with their goals and focused on accomplishing the results that
they strive for. "We feel that having a 40-plus year history in the pharmacy industry provides us with a unique perspective
on the needs of members and recognition of what does and doesn't work with benefits management" said Drew.
He explains that understanding the value of concepts such as generic substitution can make a significant difference in
plan costs; however, if the community pharmacist and the member are not appropriately educated and incentivized,
maximum outcomes are not realized. As Drew points out, "Designing an effective benefits structure requires deep
analysis of current trends for a given population and structuring a program that addresses opportunity, while maintaining
member and provider satisfaction." Rite Aid Health Solutions provides its experienced clinical pharmacist staff to
collaborate on a clients historical experience and develop a strategy to efficiently identify and address opportunities to
maximize the benefit for both members and payers.
Mail service or home delivery has become a very popular discussion topic when anyone addresses pharmacy benefits.
There is a widely recognized dichotomy that exists when trying to balance potential product cost reductions through mail
operations and the desire for member satisfaction and personal pharmacist relationship in the community setting.
Regardless of the result of any discussion on this topic, it is clear that implementing programs to reduce the cost of
maintenance quantity prescriptions is the goal of any payer.
Rite Aid Health Solutions believes that their RiteFill90 program effectively addresses this struggle. "There will always be a
small portion of any plan that is a good candidate for mail service, usually 2-3% of members" says Drew, "However, most
members resent and struggle with ordering prescriptions through the mail and losing their personal touch with their local
healthcare information source, the pharmacist".
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The company believes that it has the answer with its retail maintenance program. Under this model, the community
pharmacy, recognizing potential loss of business to mail order and realizing the reduced operating costs of filling one
prescription rather than three, is often willing to reduce its reimbursement rates for these maintenance prescriptions.
Drew points out that "historically, members will embrace a RiteFill90 plan design and deliver a much higher penetration of
maintenance prescriptions than a standard mail order program." By delivering this higher percentage of prescriptions at
reduced reimbursement rates, without forcing the member to follow a mandatory mail plan design which often results in
member dissatisfaction, the net effect is lower costs for the plan while actually increasing member satisfaction.
Rite Aid Health Solutions finds that one of its most attractive assets is its clinical pharmacy staff. A friendly, innovative
group of clinical pharmacists, they fill their day looking for opportunities to help their clients and members. From intensive
analysis of trends and individual data, they will develop intervention programs delivering education to physicians,
pharmacists and members that assist in their decisions to help the plan save costs when it is clinically appropriate. These
programs help to drive a low net cost strategy that does not attempt to inflate rebate revenue, but actually focuses on
lowest daily cost of therapy. Implementing programs such as generic incentives, co-pay waivers for cost-saving changes
in therapy, over-the-counter alternatives, when appropriate, and other plan designs embrace the ability to align the
member's consumerism and the payer's desire to reduce costs.
Drew feels that the Rite Aid Health Solution makes sense. "We have developed our strategy to respond to the needs of
today's payer, aligning complete financial transparency, embracing consumerism, and delivering innovative clinical
services. We will continue to evolve our company to respond to client needs and provide the ideas that make sense for
everyone."
Click image above for more information
Rite Aid Health Solutions
30 Hunter Lane
Camp Hill, PA 17011
1-866-828-5966
Paul Allen, VP of Sales
www.riteaidhealthsolutions.com
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