OCTOBER:  IN THIS ISSUE

"Best of the Best" Recap
Upcoming FLHCC Events & Webinars
Blog Feature: 
How to Review and Improve Your PBM Contract
NBCH Rebrands: 
National Alliance of Healthcare Purchaser Coalitions 
"BEST OF THE BEST" RECAP
This year's "Best of the Best" conference was a success as numerous health care representatives from employers across Florida were present to network and hear about current issues and trends in the industry, including implementing innovative technology for employee benefits, managing rising opioid abuse in the workplace and utilizing telehealth and weight-control programs to encourage healthy lifestyles. The day began with a delicious breakfast put together by The Walt Disney Company, our hosts at the beautiful Grand Floridian Resort & Spa.

Jared Fryksdale with Echo Global Logistics spoke first about how concierge services are impacting employer benefits. Now more than ever, em ployers are forced to be innovative with how they manage employee benefits. Echo had a small benefits department with only two personnel serving 2,000+ employees. With a 70% millennial employee population, they came up with a solution that would best fit their needs. Echo implemented a mobile concierge service app called Zest Health, changing the way employees gained access to and interacted with their benefits information. The app syncs with Echo's HRIS, and offers a live concierge line with real-time text capability, along with current plan and deductible information. It also stores ID card, direct in-network provider list, and all plan specifics. The app can even schedule appointments for employees and syncs to their calendar. Last but not least, Zest Health offers a value-added price transparency tool allowing employees to see a pricing comparison on a specific procedure.

Gaye Fortner, President & CEO of the HC21 Business Coalition, presented along with Gary Eastes, Manager of Risk and Benefits, City of Knoxville. Together, they reviewed shocking statistics on opioid abuse and the measures being taken by employers and the healt h care system to address the issue in their city. Employers may not realize, but opioid abuse is common, and it is important not to dismiss it as a possibility in your staff. The amount of opioids dispensed since 1999 has quadrupled, and addicts can cost employers nearly twice as much in medical expenses annually than non-abusers ($19,450 vs. $10,853). As an employer, what can you do to avoid these costs and keep your employees safe from addiction? Setting a prior authorization (PA) and quantity limits can help you closely monitor the use of prescription painkillers. Employers can also utilize system flags for repeat users, early refills, high doses and long durations of therapy. Other solutions include pairing Rx with nonpharmacologic therapy, prescribing lowest effective dosage and immediate release instead of extended release.

Dianne Howard, Director of Risk and Benefits Management, Palm Beach School District, ended the conference by sharing how the school district brought in telemedicine/virtual office visit programs to make routine doctor visits easier and free for staff! It started with health stations equipped with computers and necessary tools, allowing doctors to screen for various illnesses including cold and flu, earaches, fever, etc. Eventually, the program morphed from these stand alone health stations to portable medical carts, telehealth robots and suitcases with HD cameras. Stella Leviyeva, Telehealth ARNP, and Javier Morales, Telehealth Analyst, were present during the conference to give a demonstration of the telehealth suitcase.

Howard also discussed the rise in obesity in the past 20 years and what the school district is doing to assist employees with managing or losing weight. The answer was the Real Appeal program, providing personalized telephone and online support to address diet, exercise, behaviors and willingness to change. Real Appeal is fun, engaging, entertaining, and follows direct-to-consumer principles.

Overall, the "Best of the Best" event gave attendees valuable insight into the current issues and trends of the health care industry and provided realistic options for employers to implement solutions in their own workplace.

A special thank you to our speakers and host,
The Walt Disney Company.

SAVE THE DATE
 UPCOMING FLHCC EVENTS
Specialty Pharmacy & Oncology Symposium
"Strategies for Success in Managing Cancer and Specialty Pharmacy"

When: Wednesday, Oct. 12, 2016
Where: Valencia Community College
8600 Valencia College Lane Orlando, Fl 32825
"Advancing Patient Care Through Physician Dispensing and Specialty Pharmacy"  Webinar

When: Oct. 26, 2016
11:30 a.m. ET

Sponsored by:
FLHCC 24th Annual National Conference
The Health Care (R)evolution: 
Getting to Better Care and Outcomes

When:  April 30, 2017
Where:  Orlando, FL

SAVE THE DATE!

Other upcoming events include:

November 9, 2016 - "Sort Through the Rhetoric and the Noise -
Is Your Current Compounding Management Strategy Working?"

Webcast
 
Sponsored by


BLOG FEATURE
HOW TO REVIEW & IMPROVE YOUR PBM
By Tim Thomas R.Ph., Founder & Managing Director at Crystal Clear Rx (an FLHCC Affiliate Partner)

If you're reading this blog, you're most likely aware how cumbersome and intricate pharmacy benefit management (PBM) contracts can be. Negotiating these contracts properly takes a deep understanding of PBM business practices and definitions, industry-specific language, and pricing structures. 

When I review PBM contracts for clients, I'm generally grading them on the level of control my clients have. Many contracts I've viewed give all the control to the PBM over a 3 year contract term. Ultimately, you want the contract to maximize your savings and hold the PBM accountable for their performance. Some things I look for: definitions, types of claims that are/are not included in contract guarantees, term and termination language, and any other vital language that may be missing.

1) Make sure your PBM clearly defines all terms. "Generic" and "brand name" drugs are good examples of terms that might not be clearly defined in your contract. Ask your PBM for more details about how they define and classify brand and generic drugs.

2) See if "brand" versus "generic" definitions affect how your PBM reports their pricing guarantees. For example, a PBM may have a "loose" definition of how to classify a generic drug when dealing with guarantees, which allows them to claim both higher brand and generic discounts. This loose language allows the PBM to "pick" which financial guarantee bucket the drug will go into, which will affect your guarantees. Oftentimes, "discounts" may be deceiving and not be the best way to determine how your PBM is performing. You'll need to look deeper into your data to understand what you're actually paying compared to industry benchmarks. Personally, I have moved away from evaluating PBM's on AWP discounts and utilize other methods to look at their financial performance.

3)Language missing from a contract can be just as detrimental to your bottom line as included language. Understanding what should be included or excluded in contract language will help you to hold your PBM accountable for their performance. One piece of language that is often left out of a contract is tied to what types of claims are included/excluded from the discount guarantees. Some examples include usual and customary claims, zero balance claims and compound claims. If your PBM offered you a renewal with a better discount rate, they might be including or excluding claims to help them achieve what "appears" to be a better deal for you.

4) Confirm that there is language stating guarantees for each channel of the pharmacy benefit, such as retail, mail order and specialty pharmacy. It's important to address these areas with your PBM before the contract is finalized to ensure that the PBM is reasonably accountable for each separate guarantee, and that they cannot use higher performance in one area to offset losses in another. For example, if the PBM over performs on retail brand drugs and falls short on retail generic, the PBM should not be able to use the overage in the brand claims to offset the losses on the generic claims.

5) Ensure there's language allowing the option to carve out channels of the benefit. I also recommend including language that allows you to carve out mail, specialty pharmacy or rebates to save even more money.

Using the right neutral, third-party consultant with expertise in pharmacy benefits, can help to ensure your contract is set up to maximize your savings. These liaisons (Crystal Clear Rx is one) are equipped to communicate directly with your PBM and "speak their language" to help you get a contract in your best interest (and give you fair options to get out of the contract when necessary). When choosing a consultant, I would also ask them if they take ANY revenue from PBM's on ANY aspect of their business. A consultant that accepts money from a PBM may not always have your best interest at heart.

Next month, I'll discuss how to create a Specialty Rx strategy. In the meantime, please feel free to reach out directly if you have any questions or need Rx benefits advice.

Tim Thomas is a Florida Health Care Coalition Affiliate Partner, a pharmacist, and the owner and Executive Director of Crystal Clear Rx, a group specializing in pharmacy benefits consulting. For more info, visit www.crystalclearrx.com or call 303-955-7827.

NBCH REBRANDS 
Congratulations to our friends at National Business Coalition on Health, now  the National Alliance of Healthcare Purchaser Coalitions,  on their recent rebrand! We were  proud to host you this month for your 21st Annual Conference here in Central Florida and  look forward to continuing to work together in the future.
For more information about all FLHCC events and to learn more about our organization, mission, the work we do to improve health care and membership opportunities, visit  www.flhcc.org
 

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