An Easy Way to Streamline PBM Bid Reviews

Whether you’re gearing up for bid season or in the thick of it, you’re aware of the intricacies of evaluating multiple offers for pharmacy benefit management (PBM) services and determining which one will yield the best result. It’s a critical and time-consuming process to get right. You must understand complex regulatory requirements, ensure alignment with […]

Two Utilization Management Trends to Keep an Eye On

doctor holding ipad with healthcare icons

As drug costs continue to climb, ensuring you have effective utilization management (UM) strategies in place is paramount to controlling drug spend, ensuring the efficient use of healthcare resources, and ensuring members can easily access the medication they need to stay on track with their health. In a previous post, we looked at some emerging […]

3 Steps to Level-Up Your Annual PBM Plan Review

business man and woman sitting at a table in front of a laptop in discussion

Annual plan review season is fast approaching and PBMs, consultants, and payers are all actively preparing for these critical conversations. A comprehensive plan review takes time to create. From compiling key information to distilling data into an easy-to-understand narrative, you have substantial work in store if you want to get it right. Maybe you’re new […]

How a Pharmacy Benefits Optimizer Differs from a PBM

closeup of healthcare employees looking over chart on clipboard

The healthcare sector often grapples with understanding the complexities of managing pharmacy benefits, a task overseen by two types of entities: the long-standing Pharmacy Benefit Managers (PBMs) and the relative newcomers, Pharmacy Benefits Optimizers (PBOs). Understanding the nuances of their roles and how they adapt to evolving healthcare demands is crucial for organizations navigating this […]

PBM Legislation Update – How Can You Prepare?

US Capitol building

Forty-nine active Federal bills have been proposed to date with far-reaching implications on pharmacy benefit management (PBM) practices, drug pricing and affordability, and the overall healthcare landscape. It’s a complex topic and much is still unknown. However, all PBM stakeholders should understand the focus of these bills and the potential impact on the industry at […]

Drug Prices Are Going Up Again – Here’s How to Keep Costs in Check

prescription bottles on top of stack of money

It’s the start of a new year. January has flown by. About 43 percent of people who made New Year’s resolutions have fallen off the wagon. And manufacturers have kicked off their annual drug price hike.The bulk of these drug price inflations roll out in January, with more likely to follow in July. So far, […]

5 Ways to Use Analytics for Solving PBM Business Problems

Analyst working with computer in Business Analytics and Data Management System

The Pharmacy Benefits Management industry is complex, with millions of data points gleaned from thousands of sources. Using data effectively depends on systematically analyzing it to uncover patterns, insights, and trends. This analysis is pivotal for providing actionable insights, optimizing performance, and driving strategic decision-making. In healthcare, Pharmacy Benefit Managers (PBMs) can use analytics to […]

2023: A Look Back While We Move Forward

2024 business planning and strategy concept, Hand touching on download bar status to change from 2023 to 2024 for countdown of merry Christmas and happy new year by technology concept, 2024 trend

As 2023 comes to an end, we’re reflecting on key trends and changes in the pharmacy landscape as well as our evolution as a pharmacy analytics automation leader. Armed with what we’ve learned in 2023 along with a clear, innovative vision for the future, we’re heading into 2024 with a renewed commitment to helping our […]

What To Know About Carve-in VS. Carve-Out Pharmacy

closeup of healthcare employee holding an insurance claim form

Employers have to be selective with their healthcare plans. Any possible way they can find to maintain quality coverage while reducing costs is a necessity. Small and mid-sized employers, especially, will look for ways to adjust their premiums, seek cost savings from telehealth, or make any adjustments they can without compromising quality or important options. […]

The Impact of PBM Legislation in 2023

The Legal Execution Department makes an appointment with the customer to sign an agreement

The rising cost of prescription drugs has long been a concern, and legislators have been pouring over the complexities of healthcare’s supply chain to pinpoint where they might intervene to bring those costs down. Recently, pharmacy benefits managers (PBMs) have been placed in the hot seat, with speculation that their crucial “middleman” placement in that […]