The media, Congress, and the regulators have recently increased scrutiny of the Big Three PBMs and their flawed legacy business model. It’s important to know that the volume-driven, rebate-centric operating models of the largest PBMs are not the only game in town in the world of PBMs. There really is a difference in pharmacy benefits management companies. At EmpiRx Health, that difference means a clinically-driven pharmacy care approach that emphasizes patient health outcomes and stronger value for plan sponsors. But what does that actually mean? And why does it matter?
Clinically-driven means literally putting the pharmacist back in the center of the pharmacy care model
Clinically-driven pharmacy care means that our clinical pharmacists ensure that patients get the most clinically-appropriate and cost-effective medication therapies to optimize care and substantially reduce prescription drug costs. Simply put, this means ensuring that patients get the right drug, at the right time, at the right cost.
EmpiRx Health’s clinical pharmacists use AI-powered technologies and population health analytics to identify individual patient care needs. They then collaborate peer-to-peer with the patient’s prescribing physician to suggest evidence-based, clinically-appropriate changes to their drug therapies. This involves recommending lower-cost medications and/or dosing and regimen optimizations.
While a clinically-driven approach may sound good in theory, this case study illustrates the difference that putting the pharmacist back in pharmacy benefits management can make.
The clinically-driven PBM model is key to managing specialty drug costs
Our pharmacists are able to focus on true pharmacy care because unlike the legacy model used by the largest PBMs, a clinically-driven approach prioritizes value over volume. It doesn’t rely on a restrictive formulary or reduced medication access to maximize rebates and drive inappropriate utilization of high-cost therapies. EmpiRx Health’s clinically-driven pharmacy care approach instead relies on pharmacists collaborating with prescribers to produce the most effective drug mix that optimizes health outcomes while reducing costs. The result is substantially lower prescription drug spending, particularly for high-cost specialty medications.
There really is a difference in pharmacy benefits management companies
At EmpiRx Health, we don’t just manage pharmacy benefits—we provide clinically-driven, customer-first pharmacy care that’s coordinated by our expert pharmacists who have the most advanced technologies at their fingertips. The result? Improved patient health outcomes for our members and substantially lower drug spending for plan sponsors.
Learn what working with a clinically-driven PBM can do for you and why it matters. Download our eBook, “Putting the Pharmacist Back in Pharmacy Benefits Management.”
