Pharmacy benefits are crucial to any healthcare plan. However, the administration and management of a health plan’s prescription drug component can be a difficult and overwhelming task. Health plans are always looking to do more — but sometimes the resources just aren’t there. That’s when it’s critical to have the right team in place.
Complying with government regulations, negotiating discounts and ensuring the best value to members are all important, yet daunting and time-consuming tasks for those without expertise in the field. Even handling the day-to-day needs of the pharmacy benefit and the oversight of the PBM can feel problematic at best.
That’s where partnering with Tier 1 Pharmacy Consulting can make all the difference.
With our experience in the industry we can help health plans embrace opportunities that might be limited by time and resources. We will make sure the health plans’ pharmacy team is working effectively and efficiently. What’s more, the right solutions and strategy can bring huge savings to the plan during a time when drug costs continue to rise.
Every health plan is unique — and every situation is different. But how do you know if Tier 1 is right for your health plan? Here are a few ideas on what strategies we offer and how they might work for you.
- We are experienced in application support. The application process involved in pharmacy benefits is time-consuming, whether it’s for a new contract filing or the expansion of a service area. It’s especially challenging for healthcare plans that lack the right people to get the job done. A knowledgeable team can help healthcare plans navigate the application process and provides support from start to finish. Our team will answer questions and complete the entire process in a thorough and efficient manner.
- We have extensive expertise in audit support. Audit support is crucial, as plans continue to face monitoring and review by the Centers for Medicare and Medicaid Services. You want to ensure you are ready when that engagement letter is sent. Tier 1 has a grasp on the ins and outs of what CMS expects, and we can ensure your health plan aligns with federal and state rules, regulations and guidance in the event of an audit.
- We understand the delegation to your PBM. Delegation Oversight is an important area of focus for all plans that offer prescription benefits – but many plans continually wish they could do more. At Tier 1, we have experience in working at a PBM. We know exactly what the PBM is doing, what its functions should be and how to spot issues quickly. We understand the detail the PBM is conveying, and we can help translate that to effective P&Ps for your plan. We will help you implement strong oversight and monitoring activities that evaluate the day-to-day operations of your FDRs.
- We work best with strategy in mind. An effective clinical strategy can make the difference for a health plan. Strategic goals allow a plan to provide member-focused initiatives designed to improve healthcare delivery and keep their members engaged in their personalized treatment. A great strategy combines clinical practice and evidence-based medicine, so it can help plans implement and develop programs that lead to quality health outcomes for members, boost overall plan performance and ensure ROI.
- We provide personal service. At Tier 1 we work side-by-side with the health plan every day, constantly striving to improve the plan’s value and save everyone money. A health plan should always feel as though its vendors are on the same side, working tirelessly to bring results. A little personality doesn’t hurt, either.
There you have it — a few ideas of why we think we would be a great fit for your health plan. Want to learn more? Email info@tieronepc.com for even more solutions to the prescription drug benefit of your health plan.
About Tier One Pharmacy Consulting
Tier 1 Pharmacy Consulting is a Denver, Colorado-based pharmacy benefit consulting firm offering customized services to healthcare plans that offer prescription drug benefits. Whether your health plan is big or small, Tier 1 offers strategic, cost-saving solutions that boost the plan’s overall value and help its members by providing high quality care.
We work hard for our clients – and we prove that by keeping their best interests at heart and striving to save them money. It’s an ongoing process. It’s one we don’t take lightly.
Tier 1’s founder is a clinical pharmacist with over 10 years of experience in pharmacy benefit management. That makes our team especially passionate about collaborating and developing effective strategies to improve health plan outcomes. The right PBM can reduce healthcare costs by securing regulatory compliance, proper drug utilization and overall patient adherence.
Tier 1 offers health plans a new perspective on how to manage their pharmacy benefit. We are experts in making effective plans stronger as well as improving areas that may be problematic due to time constraints or lack of resources.
We are here to help. Let’s talk about how we can be there for your health plan.
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