Ambulatory Pharmacy – The Health System’s Prescription Benefit Contract

By Gregory K. Shaeffer MBA RPh FASHP

Is your hospital or health system maximizing the cost savings opportunities for your system?

An important component of the healthcare benefit offered to the employees and dependents of the health system is the prescription benefit.

Prescription drug costs represent approximately 25% of the total cost of employer sponsored health benefits and even larger percentage of the increase in the cost of the total medical benefits. The health system is unique in the opportunity to maximize cost savings and or mitigation of this rapidly increasing segment of benefit cost.

There continues to be on-going discussion for the need of “transparency” in PBM contracting.  The term “transparency” has been grossly overused and ill- defined in evaluating prescription benefit contracts and contract models.

This introductory blog is the first in a series that will introduce and explore the various contracting models available and benefits and limitations of each.

In subsequent blogs we will explore in greater detail the specific tenants that demonstrate the advantages and disadvantages to the various contracting model.