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Pharmacy Consulting

Prescription drug benefits are an ever-increasing cost to group health plans and comprise about 15 to 20 percent of health plan expenses. Industry estimates show prescription drug benefits have begun a steady rise in year-over-year expense-to-health plan costs, with predictions of even higher increases in the future. At CBIZ ESO, we understand the need to curb these costs and control health plan expenses, which is why we created the National Pharmacy Consulting Practice. This practice brings robust clinical and consulting expertise to clients and other CBIZ ESO teams when it comes to navigating the ever-changing landscape surrounding the pharmacy benefit.

As our client, the CBIZ ESO pharmacy practice team will consult with you to review past pharmacy experience and provide strategic recommendations specific to your organization’s needs and culture while also providing guidance around best practices for pharmacy management. The practice offers you a breadth of pharmacy expertise ranging from marketplace perspectives and vendor capabilities to valuable practical and clinical knowledge. The pharmacy team collaborates with local CBIZ ESO consultants and actuarial teams to provide pharmacy-specific guidance pertaining to health care reform, industry trends and your objectives. The team will also work with current or prospective pharmacy benefit managers (PBMs) to maximize the value of each dollar spent on pharmacy by:

  • Achieving the best price through contract renewals and performance guarantees
  • Ensuring the safe and appropriate use of medications through clinical recommendations
  • Working with vendors to optimize distribution channels, including site of care
  • Collaborating with vendors to ensure adequate reporting of pharmacy expenditures
  • Ensuring medical, disease management, and PBM vendors are accountable for medication adherence and outcomes
  • Aligning strategies to prepare for impactful drug launches or guideline changes and clinical recommendations to mitigate upward-trend pressures
  • Meeting the needs of state and federal regulations, including provisions of health care reform

The National Pharmacy Consulting Practice works closely with large, self-funded plan sponsors and performs a variety of strategic consulting services, including but not limited to:

  • Carrier or PBM pharmacy contract review
  • PBM (procurement)
  • Plan design and benefit management
  • Implementation oversight
  • Market check (as allowed in current contract)
  • Annual pharmacy experience review and clinical recommendations
  • Vendor management
  • Retiree-specific drug strategies, including Employer Group Waiver Plan (EGWP) and Retiree Drug Subsidy (RDS) support
  • Ad hoc projects (e.g., onsite pharmacy, 340B optimization, etc.)

Download our Pharmacy Consulting service overview to learn more.

Our national expertise enhances and supports our locally-delivered benefits consulting, payroll services and HRIS technology in every CBIZ ESO office nationwide.

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