What You Should be Doing Now to Optimize Your Pharmacy Benefit for 2023

March 8, 2023

Justin Venneri

Starting the New Year off with good intentions and on the right foot with a solid game plan toward making personal or professional progress via New Year’s resolutions is the American way, right?

For plan sponsors and other health plan stakeholders, making a dent in the total cost of care is likely a priority for 2023. Why wouldn’t it be when rising out-of-pocket costs1, premium hikes2, and astronomical prices for newly approved drugs3 dominated fourth-quarter 2022 headlines?

The truth about drug prices...

Generic drug prices have been falling for a decade, and brand deflation is a more recent phenomenon4. So why has pharmacy spend been a primary source of cost inflation for health plans for years, rising to 30% or more of total health plan costs in some cases? Perhaps it has to do with an irrational drug price index (I.e., AWP) being the backbone of legacy pharmacy benefit manager (PBM) contracts with benefit plan sponsors.

To help think through how progress can be made, I separately asked several members of the Capital Rx leadership team - President Matt Gibbs, PharmD; Chief Growth Officer Kristin Begley, PharmD; Senior Vice President of Strategy Josh Golden; Senior Vice President of Pharmacy Sara Izadi, PharmD; and Chief Strategy Officer Joe Alexander - one question:

What are the top few suggestions you would give an employer/plan sponsor today to help them optimize their pharmacy spend in 2023?

The results are in, and given the fiduciary responsibility plan sponsors have, this list of tactical and strategic suggestions should be helpful for so long as the status quo, legacy PBM model dominates the market.

Keys to Impacting Your Pharmacy Benefit Spend

Vendor Alignment

Double-Check Your Contract (and Biosimilars Strategy)

Review Your Plan Design

Keep Your Employees Healthy & Productive

The Cost of Pharmacy Benefits Can Be Controlled... or at Least Explained!

Get in touch if you’d like to discuss or learn more about any of the above, our validated PMPM savings, or how Capital Rx’s account management teams and JUDI®, our next-generation enterprise pharmacy platform, can help with tactical and strategic decisions.

It is possible to mitigate rising or unnecessary pharmacy benefit costs with the right partner.

We’d love to hear from you!

1 Out-of-pocket health costs spiked in 2021 (Axios; December 15, 2022)

2 Inflation Threatens to Send Health-Care Premiums Surging (1) (Bloomberg Law; October 27, 2022)

3 FDA approves world’s most expensive drug at $3.5M a dose (ALM Benefits PRO; November 28, 2022)

4 Brand-Name Drug Prices Fell for the Fifth Consecutive Year—And Plummeted After Adjusting for Inflation (Drug Channels; January 4, 2023)

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