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RX TOOL

Pharmacy Consulting

Pharmaceutical costs account for 17% of our clients’ overall healthcare spending. These benefits are some of the most commonly used, as well. Thus, designing a pharmacy benefit strategy that fits your budget and the needs of your employees is key when it comes to keeping your healthcare costs in check.

So, how do we do it? We employ a full-time Pharmacist here at GBS Benefits. His expertise, along with your pharmacy claims data, gives us a complete look at your pharmacy benefit management. We don’t look at your pharmacy claims in isolation, however — we integrate what we know about your pharmacy spending with your medical claims. That way, we’re able to give insight into your population and your spending, then make recommendations to control your costs.

Has your PBM contract become overly complicated? Have you run into issues with your pharmacy network? Do you need to carve out your pharmacy benefits? Our team can help. Prescription drug pricing varies, depending on the drug and the pharmacy. We have tools that compare pricing and help your employees comparison shop for their prescriptions. It’s possible to control your pharmacy costs, and GBS Benefits has the expertise and tools to help.

Pharmacy Consulting FAQs

Some of our most frequently asked Pharmacy questions:

Do generics work the same as brands? 

A generic drug is the same as a brand-name drug in dosage, safety, strength, quality, the way it works, the way it is taken, and the way it should be used. The FDA requires generic drugs to have the same high quality, strength, purity, and stability as brand name drugs. Generic drug makers must prove their drug is ‘bioequivalent’ to the brand name drug — which means that it works the same in the body.

Do medicine prices vary by pharmacy?

Like products sold by any other type of business, the cost of medicines can vary (sometimes substantially) from pharmacy to pharmacy. Differences in the cost of doing business (high rent area vs. low rent), the presence/absence of competition, or differences in acquisition costs between two pharmacies can all play a part in a prescription costing more at one pharmacy than another. Prescription pricing is typically more complex than other goods due to the role that 3rd party payers like health plans or pharmacy benefit managers play in medication pricing. The best way to know whether or not you’re getting a good deal on your medication is to shop around and compare pricing by pharmacy.

What is a compound drug?

A compounded drug is a mixture of one or more active pharmaceutical ingredients into a new preparation, often to meet the unique needs of a particular patient. Compounds can be used to adjust the dose or strength of a medication, to change the form of a medication (from an oral tablet to a syrup, for example) or, in the case of specific allergies an individual might have, to remove non-essential ingredients. Several complications exist with reference to compounds. They can often be quite expensive or unnecessary, and some have not been proven effective in a topical vs. oral form. Many plans do not cover compounds or put tight financial controls in place to protect members and plan sponsors.

What should I do if I miss a dose of my medication?

A general rule for a missed dose of a medication, like an antibiotic or anti-hypertensive medication, is to take the missed dose as soon as you remember. If it is nearly time for your next dose, skip the missed dose altogether and simply take your next scheduled dose when it is time. If you frequently miss doses of medication, it may be a good idea to establish a reminder system (an alarm, text reminder, etc). If you take more complex medicines like injectables or those with very specific therapeutic indexes, like seizure medicines, consult your pharmacist for more information on what to do in the case of missed doses.

How do I transfer a prescription from one pharmacy to another?

Transferring a prescription to a new pharmacy is quite easy. You don’t need to contact your doctor for a new prescription. Simply call the new pharmacy (the one you want to transfer your prescription to). Tell them you have a prescription at another pharmacy and you’d like to transfer it to the new pharmacy. The new pharmacy will take it from there — they will call the old pharmacy and request the transfer on your behalf. If the prescription is still current (if you have additional refills remaining), then the new pharmacy will be able to fill it for you. If it is expired, the new pharmacy can contact your physician for a refill authorization. It is possible that you will need to see your doctor for a new prescription, but that would likely have been necessary even at the original pharmacy.

Can my company carve pharmacy out from our current medical carrier and contract directly with a pharmacy benefit manager (PBM)?

Carving out pharmacy is possible, and can often result in lower costs than the current health plan carrier is offering. The benefit of carving out pharmacy is a greater degree of plan flexibility, data access, and often, lower costs. Health plan carriers will often prohibit this change or charge substantially increased admin and data integration fees for doing so. Contracting with a stand-alone PBM is an excellent option for many self-funded groups. We advise employers to consider all your benefits options to find the ones that best fit your needs.

We'll formulate The Best Pharmacy strategy For Your Business

We’ll help you understand your pharmacy costs and design a strategy to achieve your objectives and control your costs.

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