Pharmacy contracts can be a complex and often overlooked aspect of employee benefits, yet they play a critical role in managing healthcare costs and ensuring employees receive the medications they need. For employers, understanding pharmacy contracts and the process of pharmacy reconciliations is essential to avoid overpaying and to ensure that both our clients and their employees are getting the best value for their prescription benefits.
At BSI, we understand the intricacies of pharmacy contracts and the importance of regular pharmacy reconciliations. Here’s how we ensure our clients are always protected:
What Are Pharmacy Contracts?
Pharmacy contracts are agreements between employers (or their benefits administrators) and pharmacy benefit managers (PBMs), health insurance providers, or pharmacies themselves. These contracts outline the terms, pricing structures, and policies that determine how prescription drugs are covered, what the costs are, and which medications are included in a formulary. A pharmacy contract can include various components, such as pricing models, referencing discounts and rebates, formulary management determining what level of cost sharing is associated with each drug, incentives offered by drug manufacturers and how prescriptions are submitted and reimbursed under the plan.
Without the right oversight, employers may not realize they are paying higher than necessary for certain medications or that certain rebates or discounts are being missed. This is where BSI steps in to help.
Pharmacy Reconciliation: Why It’s Essential
Pharmacy reconciliation involves reviewing and auditing pharmacy claims to ensure that payments are being made accurately according to the terms set forth in the contract. This process helps identify discrepancies between what was paid for prescriptions and what was agreed upon in the pharmacy contract. This can include verifying whether rebates have been applied, whether the correct pricing has been used, and if any charges are over or underpaid.
Pharmacy reconciliations are essential because without this step, employers could be unaware of overcharges or missed opportunities to lower prescription costs. Additionally, many pharmacy contracts include complex terms related to rebates and formulary changes that can significantly impact the total cost of medications.
How BSI Protects Clients
- Thorough Contract Analysis: We start by thoroughly reviewing pharmacy contracts to ensure our clients are getting the best pricing, coverage, and rebates possible. We compare current contracts against market standards and identify any potential areas for improvement.
- Negotiating Better Deals: As experts in employee benefits, BSI negotiates with PBMs and pharmacies to secure better pricing, improve rebate structures, and ensure that contracts align with clients’ evolving needs. This can result in lower overall costs and more favorable terms for our clients.
- Regular Reconciliations: Our team conducts ongoing pharmacy reconciliations to ensure that no errors are being made in claims processing or rebates. By regularly auditing prescription claims, we can identify discrepancies and ensure that clients are not overpaying.
- Proactive Updates: We keep our clients informed about any changes to pharmacy contracts or regulations that may affect pricing or coverage. If a contract is no longer favorable, we help our clients make informed decisions about renegotiating or switching programs.
- Tailored Solutions: We understand that every client has unique needs, which is why we offer personalized solutions based on the specific requirements of our clients. Whether it’s adjusting formularies or exploring alternative programs, we are dedicated to maximizing value and minimizing unnecessary costs.
The BSI Advantage
At BSI, we are committed to helping our clients navigate the complexities of pharmacy contracts and reconciliations. We provide continuous support to ensure that every aspect of their pharmacy benefits is optimized to drive down costs and improve overall healthcare outcomes. By partnering with BSI, our clients can rest assured that they are not only complying with the best practices in pharmacy management but also securing the best possible value for their employees.
With BSI’s expertise, clients are protected from overpaying for prescription medications and can ensure their employees have access to the care they need at the best possible cost.