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pharmacy experts
30+
financial and actuarial professionals
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licensed pharmacists
Pharmacy benefits consulting services
This is one of our most popular services and a great fit for employers of all sizes and industries. We provide oversight and help plan pharmacy benefits.
Our services include:
- Ongoing advocacy on any issues related to pharmacy benefits
- Annual pharmacy strategy development
- Extension of benefits team for managing pharmacy benefit managers (PBMs) or health plans
- Benchmarking and recommendations on vendors and programs
- Implementation support to ensure smooth transitions and integration with third-party vendors
- Financial and benefit audits to maintain compliance and accuracy
- Vendor management and issue resolution for members
Our services include benchmarking plan design to assess whether your pharmacy benefits are competitive and aligned with industry standards. These services are best suited for employers that have in-house staff to manage vendors but need an annual assessment based on marketplace changes.
Our services include:
- Benchmarking plan design — ensures benefits are competitive
- Identification of key cost drivers — helps manage and reduce expenses effectively
- Clinical overviews — ensures care provided meets high medical standards
- Compliance and disease management
- Pipeline analytics — watches for new therapies on the horizon and identifies potential plan specific impact and potential utilization management and coverage approaches
- Innovation — identifies new trends, programs, vendors and innovations in pharmacy care to allow for consideration of progressive opportunities for benefit plans
Specialty drug costs continue to accelerate, trending at 15% to 20% and exceeding up to 60% of total pharmacy spend for many employers. With emerging high-cost drugs, gene and cell therapies entering the market, you need strategies to control costs. Our pharmacy experts can analyze your utilization and recommend strategies specific to your organization. We recommend an in-depth review of specialty spend annually given the growth of million-dollar therapies.
Our services include:
- Specialty dashboard — provides real-time information and data to allow for changes in pharmacy benefits strategy
- Diagnostic services — finds inefficiencies and opportunities for strategic decision making, improving overall program effectiveness
- Vendor summits — brings together key stakeholders to foster collaboration, align goals and ensure that all vendors are committed to meeting your organization’s needs
Our services improve your pharmacy benefits through benchmarking, market analysis, competitive renewals, strategic marketing initiatives, assessment of alternative pricing structures and vendor partnership models and diligent contract negotiations. We’re successful in negotiating better terms, resulting in significant value to your organization.
Our services include:
- Market checks — ensures your contract has best-in-class pricing
- Competitive renewals — reviews current contract terms and ensures your organization has the best negotiated terms and financials when renewing with an incumbent vendor
- Competitive marketing initiatives and requests for proposals — manages the process to attract the best vendors and foster a competitive environment that encourages high-quality services at competitive prices
- Contract negotiations — secures the best terms for your organization, focusing on cost efficiency, service quality and clear and meaningful measurement of service and financial performance guarantees
Our services analyze accuracy in pricing, rebate performance, drug coverage and plan-design rules. Most of our clients engage in pharmacy audits at least once every three years, while some audit their PBMs annually.
Our services include:
- Discount and fee validation — ensures that you receive the agreed-upon financial terms, negotiated prices and fees with PBMs and vendors, holding them accountable and transparent
- Drug price variance analysis — benchmarks against acquisition cost and other models
- Rebate guarantees and pass-through audit — ensures vendors are correctly passing savings to you in compliance with contract commitments
- Plan benefit design — includes assessing the accuracy of claims performance relative to the expected rules for the plan’s formularies, copay structures and other pharmacy benefits that match clinical effectiveness and ensure compliance with plan parameters
- Clinical and operational reviews — assesses the efficacy and efficiency of your pharmacy benefit programs
- Pre-implementation audit — validates the readiness of the PBM to effectively administer a new plan or significant plan change updates accurately in their claim adjudication system to find inaccuracies before members begin the new benefit
Our services go beyond PBMs to offer support with alternative vendors. We’ll analyze investment feasibility and return on investment, manage vendor procurement, assess operational effectiveness and outcomes and negotiate contracts to align with your strategic goals in pharmacy benefits management. These may include PBM overlay, pharmacogenomics, onsite pharmacy, metabolic health, mental health and fertility vendors.
Our services include:
- Feasibility and return on investment analysis — evaluates potential investments or changes in your pharmacy benefits plan
- Vendor procurement — manages the entire process from vendor selection to finalizing agreements
- Operational and outcomes assessments — measures how well your PBM works by looking at how it runs, how patients progress and looks for areas to improve
- Contract negotiations — enables us to secure favorable terms that align with your strategic goals
Our Comprehensive Condition Care offering is designed to help you create a treatment strategy to address diabetes and obesity, using our analytic tools and coordinated team of subject-matter experts across pharmacy, health, equity and wellbeing and health analytics
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Pharmacy Guardian
Pharmacy Guardian is a suite of our consulting services that helps assess whether you’re properly serving your fiduciary duty by developing and executing a comprehensive plan on an ongoing basis. We provide secure pharmacy pricing by conducting gap analyses, audits and contract negotiations. We offer resources for managing high-cost categories, expert guidance and access to a benchmarking database, helping you achieve significant cost savings with top-tier pharmacy contracts.
Our comprehensive suite of pharmacy solutions
Rx Direct Access
As the cost and demand for GLP-1 medications for weight loss exponentially rises, employers are looking for ways to make covering these drugs more affordable and predictable. Our 2025 Best Practices in Healthcare Survey shows that 48% of employers are covering GLP-1 medications for weight loss (78% cite lower medication costs as a factor in their coverage decisions). With net annual costs of $7,000 to $8,000 per user, many employers are taking a hard look at how to provide affordable and reasonable access to GLP-1 drugs for weight loss. For 6% of employers, the costs have become unsustainable, and they have made the decision to remove coverage of GLP-1s for obesity. Another 9% of employers are considering similar action by 2027.
48% Employers cover GLP-1 medications for obesity
This is where our solution, Rx Direct Access, can help. We’ve partnered with Virta, RxSaveCard and Vida to develop an innovative direct-to-patient approach for GLP-1 weight loss prescriptions. This way, these prescriptions are excluded from standard formulary and benefit structures. This approach involves Virta and Vida clinicians determining the appropriate treatment journeys for members.
Key benefits
The program offers several benefits for plan sponsors and members:
- Clinical wrap: Virta and Vida clinicians and health coaches support members, ensuring proper use, side effect management and adherence
- Transparent consumer pricing: Eliminates rebates by providing transparent pricing
- Lower costs: Offers lower prices compared to typical payer prices of $700–800 per script (net of rebates)
- Flexibility: Allows for flexible member cost-sharing arrangements
- Potential savings: Provides potential savings and trend mitigation for plan sponsors
Partnership and support
Through Rx Direct Access, we’ve partnered with Virta, RxSaveCard and Vida to offer a subsidy program for members. We provide opportunity assessment and outcomes analysis to bring this solution to life.
This collaborative approach ensures that members receive the support they need. Plan sponsors can benefit from transparent, predictable pricing through a funding mechanism, alongside clinical journey support for members.
Pharmacy benefits services
Pharmacy Benefits Consulting solutions
Health and Benefits
We partner with you to build an effective employee benefits program that sustains a healthy, high-performing workforce.
Employee Wellbeing
We unlock the business value of employee wellbeing, boosting the effectiveness of total rewards, increasing employee engagement, and improving work-life balance, performance and productivity.
As the pharmacy benefits industry faces its most intricate challenges yet, we’re proud to stand as leaders in pharmacy program advocacy. For over two decades, our pharmacy practice has been at the forefront, negotiating contract protections and pricing to help our clients receive the best possible terms. As the market evolves, so do we, always ready to anticipate and meet the needs of our clients.