Industry experience, clinical expertise, and proprietary analytics make the difference

Rising healthcare costs and uncertainty about the Affordable Care Act have created a lot of confusion for employers about healthcare benefit options. Perhaps the most significant concern is the escalating cost of pharmaceuticals, often the first line of defense in managing many specialty disease states. Consider this - prescription drug prices have increased nearly 10 percent in the last three years. According to Truveris NDI (National Drug Index), drug prices have inflated 318 percent more than the price of all goods in the U.S.

Today, 20 to 30 percent of overall healthcare dollars are spent on pharmacy benefits, making them the most widely utilized aspect of an employer’s healthcare benefit plan, while only 50 percent of health plan members utilize their pharmacy benefits every month. Depending on the age and health of plan membership, pharmacies fill an average of 12 to 35 prescriptions per member over the course of a year. High-cost specialty drugs, such as those to treat cancer or chronic illness, comprise up to 30 percent of pharmacy plan spending. Yet, these specialty drugs make up only one percent of all drugs purchased and are used by only a small percentage of the population. Few companies have a strategy in place to manage these high-cost drugs, some of which exceed a $1,000,000 per year.

As a Western New York employer, it is crucial to understand the factors that contribute to the steady increase in pharmacy costs. By addressing the necessary issues related to a pharmacy benefits package, Premier Consulting Associates helps employers understand this complex and expanding market and arrive at cost-effective and efficient solutions. Using a locally-based pharmacy benefit management consultant can help your company provide the best benefit options to employees, while managing the risks and costs of healthcare expenses.


Experience and Clinical Expertise


The team at Premier has the organizational experience from top to bottom to help companies navigate pharmacy benefits. They have inside knowledge of how Pharmacy Benefit Managers (PBM) operate, because the pharmacy leadership team has several years of experience working directly for PBMs. Premier also works closely with pharmacists to analyze the financial and clinical differences in PBM formularies to ensure that healthcare plan participants get the right drug, at the right time and at the right price. This approach, combined with the most accurate data analytics and cost predictive modeling, is an advantage to understanding and containing escalating plan costs.

Analytics that Work for You

The operational environment of a PBM is purposefully opaque, because their revenue depends on the unseen difference between manufacturer discounted prices and what you pay for those drugs at retail. Premier has an analytics team and proprietary data management tools that allow them to review line-by-line data of each claim adjudicated by pharmacies. Premier can identify savings opportunities with this data that their competitors miss when using standard PBM reporting tools. Premier has uncovered millions of dollars in cost savings by performing full claim audits and annual reconciliations of contract terms versus actual discounts and rebates paid. This type of information, coupled with inside knowledge of PBM strategies, guarantees that your pharmacy costs always remain in check.


All Inclusive Assistance


Premier has been successful in working with the manufacturers of high cost specialty drugs to get employee and employer financial assistance, which has resulted in saving employers millions of dollars. The team also has experience helping employers implement government subsidy programs, such as Medicare, EGWP, and 340b to offset additional plan costs.

Premier offers a full scope of healthcare and pharmacy benefit management services, including self-funded benefits consulting, stop loss insurance, cost containment and wellness programs. There’s a better way to navigate your employee benefits – it’s Premier. For more information, contact Vice President Ted Butler at 716.688.5600 extension 259 or visit premierconsultingassoc.com.


About Premier Consulting Associates, LLC


Premier Consulting Associates, LLC is an independent consulting firm in Amherst, New York that partners with employers of all sizes in managing health care benefits. Established in 2004, it is a national leader in experience rating and self-funded methodologies who currently manage over $1 billion in healthcare claims and market over $10 million in stop loss premiums. They also offer alternative funding mechanism and perform a full range of consulting services relating to plan design, implementation, employee and vendor communications, recommendations regarding current stop loss and future benefit plan options. They specialize in the operational procedures and processes of carriers and Third Party Administrators. They have experienced team members who analyze the carrier capabilities and program to match the client’s needs. To learn more, visit http://www.premierconsultingassoc.com or call at 716.688.5600.