Page 29 - Upstream Rehabilitation
P. 29
Pharmacy
Pharmacy analytics
Member cost share/specialty
• Specialty drug predictive modeling tools Ongoing pharmacy
• Focus on medication adherence improvement consulting
MEMBER DETAILED
Objective and transparency COST-SHARE CLAIMS PERFORMANCE MANAGEMENT
• Rigorous inancial valuation of proposals STRATEGIES ANALYSIS • Continued engagement with PBM vendor
to ensure delivery of plan performance
• Not limited to Lockton collectives reporting and review meetings
• Winning PBM must agree to client’s • Advocacy and facilitation of service or
contractual provisions, guarantees, SPECIALTY DRUG performance issues
and independent audits SPEND CLINICAL PROGRAM
MITIGATION PBM
Prospective cost modeling MARKETING OPPORTUNITIES
• Client-focused RFP • Comprehensive clinical program review
with recommendations on new program
• Focus on key metrics Lockton Pharmacy implementation, beneit design, and plan
limits
• Financial and technical analysis CLINICAL Analytics • Formulary optimization focused on
• Finalist meetings (as needed) SAVINGS generic utilization, preferred medications
ANALYSIS PROSPECTIVE and lowest net cost
Contract optimization COST MODELING STRATEGIC PLANNING
• Establish clear contractual • Ongoing evaluation of new programs,
deinitions products, and services available to
• Structure $ for $ Performance manage utilization and costs
Guarantees FORMULARY CONTRACT • Develop strategy for continuing to ensure
• Structure objective audit procedures MANAGEMENT OPTIMIZATION pharmacy program is market competitive
and effective for members
• Deine clear algorithms for guarantee and
penalty calculations
Formulary and network analysis and recommendation
• Specialty carve-out opportunities (e.g., hemophilia)
Upstream Rehabilitation — Lockton Total Rewards Practice overview 29 Lockton Companies
Pharmacy analytics
Member cost share/specialty
• Specialty drug predictive modeling tools Ongoing pharmacy
• Focus on medication adherence improvement consulting
MEMBER DETAILED
Objective and transparency COST-SHARE CLAIMS PERFORMANCE MANAGEMENT
• Rigorous inancial valuation of proposals STRATEGIES ANALYSIS • Continued engagement with PBM vendor
to ensure delivery of plan performance
• Not limited to Lockton collectives reporting and review meetings
• Winning PBM must agree to client’s • Advocacy and facilitation of service or
contractual provisions, guarantees, SPECIALTY DRUG performance issues
and independent audits SPEND CLINICAL PROGRAM
MITIGATION PBM
Prospective cost modeling MARKETING OPPORTUNITIES
• Client-focused RFP • Comprehensive clinical program review
with recommendations on new program
• Focus on key metrics Lockton Pharmacy implementation, beneit design, and plan
limits
• Financial and technical analysis CLINICAL Analytics • Formulary optimization focused on
• Finalist meetings (as needed) SAVINGS generic utilization, preferred medications
ANALYSIS PROSPECTIVE and lowest net cost
Contract optimization COST MODELING STRATEGIC PLANNING
• Establish clear contractual • Ongoing evaluation of new programs,
deinitions products, and services available to
• Structure $ for $ Performance manage utilization and costs
Guarantees FORMULARY CONTRACT • Develop strategy for continuing to ensure
• Structure objective audit procedures MANAGEMENT OPTIMIZATION pharmacy program is market competitive
and effective for members
• Deine clear algorithms for guarantee and
penalty calculations
Formulary and network analysis and recommendation
• Specialty carve-out opportunities (e.g., hemophilia)
Upstream Rehabilitation — Lockton Total Rewards Practice overview 29 Lockton Companies
