Cómo diseñar su RX
As an employer, finding the right prescription plan is an important factor in your employee benefits offerings. If you’re looking for a way to reduce costs and give your employees better options, then carving out your RX is a good idea.
A pharmacy “carve-out” allows a plan sponsor to choose a Pharmacy Benefit Manger (PBM) to manage prescription drug benefits on their own. They are standalones from the PBM who is contracted with the health plan which administers claims. Carve-out RX plans can be either fully insured or self-funded.
The advantages of “carve-out” plans provide a strong case for switching gears on your plan. Here’s how to carve out your RX for the benefit of your personal budget or employee benefits plan.
How to “Carve Out” Your RX
The first step is to begin the carve-out process with an employer’s health plan for prescription drug coverage. Prescription benefits are one of the best money makers for insurance carriers and even specific PBM’s, but that doesn’t have to mean you lose money. Small employers with 50 or fewer employers can now use self-funded prescription plan options to reduce costs.
El siguiente paso es utilizar el administrador de beneficios de prescripción adecuado. El objetivo es identificar uno que sea transparente y que trabaje claramente para usted, no para las compañías farmacéuticas o de seguros. Solo deberían cobrar por las recetas procesadas. Con su ayuda, puede aislar los reembolsos que le permitan ahorrar costos.
Another important part of this process is to do your own research. It’s a good idea to understand how the Precios promedio al por mayor (AWP) discounts work. The primary reason is to get a good handle on what pricing is acceptable and what isn’t. Discounts aren’t always the most important selling point. High discounts could in fact reveal a higher mark up on prescription costs for generic drugs than is acceptable. Higher priced drugs are particularly vulnerable to this type of ‘up-selling’. A professional PBM can isolate the correct pricing for your prescription plan reducing the overall costs.
Finally, hiring a transparent PBM not only helps you reduce costs based on a consistently lower prescription drug plan, it also enables you to reap benefits as factors change within the industry. They also guarantee compliance, disease management and advocacy for your employees. To determine how to carve-out your RX plan, talk to a specialist at Primary Care Insurance Solutions.
3 ventajas de desmantelar tu RX
Los PBM ofrecen descuentos inmediatos y mayor claridad en los planes de beneficios para empleados. Pero aquí hay tres beneficios específicos de usarlos para desglosar sus beneficios.
- Los diseños de planes flexibles reducen los costos
En lugar de pagar por la cobertura de medicamentos recetados que rara vez se usan y que son extremadamente costosos, puede trabajar con un PBM que, a su vez, puede crear un plan detallado que sea flexible a las necesidades de sus empleados. Esto le permite adaptarse al mercado, reduciendo la cobertura en áreas donde los precios son más altos de lo normal. La flexibilidad siempre es una ventaja en el mercado de seguros.
- Reembolsos de transferencia
Professional PBMs allow you to get better pricing through rebates. They will invoice you for every drug dispensed according to the PBM’s cost for the drug. This means you get prescriptions at wholesale prices after rebates. These pass-through costs are one of the greatest advantages to carve out RX plans.
- Derechos de auditoría
With a carved-out prescription plan, you have the right to audits. This includes claims audit, operational assessments, and rebate audits. This guarantees complete transparency on costs and expenditures. Access to pharmacy claims data also ensures you’re getting the best deal available.
Los empleadores se benefician enormemente de los planes de exención de responsabilidad
Cost containment is the number one reason of carving out your RX plans. Prescription drug care is by far the most used healthcare coverage employee benefit. Pharmacy costs take care of about 30% of all healthcare costs. With an increase in prices for prescription drugs, it’s logical that employers will turn their attention to carve-out plans for their employees.
If you’re interested in better controlling pharmacy benefit costs, then carving out prescription drug benefits from your major-medical plan, is a good route to go.
Para beneficiarse de precios transparentes de medicamentos, control de auditoría, costos reducidos de recetas y mucho más, considere crear un plan de medicamentos recetados para los beneficios de sus empleados.
For more information about carving out your RX in Texas, contact the Primary Care insurance Solutions team. We’d be happy to help.
Preguntas frecuentes
What does “carving out your RX” mean in terms of prescription plans?
What’s the purpose of choosing a transparent Prescription Benefit Manager (PBM)?
What are the primary advantages of using a PBM to “carve out” an RX plan?
1. Diseños de planes flexibles que pueden reducir costos al adaptarse a las necesidades de los empleados.
2. Reembolsos directos que permiten a los empleadores obtener recetas a precios mayoristas después de los reembolsos.
3. Derechos de auditoría que garantizan una transparencia total sobre los costes, incluidas auditorías de reclamaciones y auditorías de descuentos.
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