Pharmacy Advisory, Auditing and Risk Management Services

Pharmacy benefits for active employees are often a black box to plan sponsors.  Either the benefit is carved in, so there is very little transparency, or the pharmacy benefit management (PBM) contract is too complex to be understood in its entirety.  Because of this lack of transparency, pharmacy benefits are an area where plan sponsors are often paying too much, not understanding the drivers of cost and have very few tools to help contain costs.  In order for our clients to better understand and control the cost of this benefit, KTP has developed a robust advisory practice in the area of pharmacy benefits.

Our PBM advisory services start with a deep understanding of the contracting and RFP process for selecting pharmacy benefit vendors.  Next, KTP applies our knowledge of best practices in clinical programs and cost containment strategies during the implementation process.  Finally, we provide ongoing auditing and risk management services to ensure that our clients’ health care dollars are well-spent.  Our practice is not transactional.  KTP endeavors to develop a long-term strategic relationship with our clients that leads to lower cost trend and reduces spend, without sacrificing clinical outcomes or member satisfaction.

The savings of this approach cannot be achieved with the traditional methods of retrospective audits and reviews. All aspects of risk management are included in our comprehensive approach to pharmacy benefit risk management:

  • Strategic planning
  • PBM RFP marketing
  • PBM contract review & negotiations
  • Vendor implementation management
  • Claims auditing
  • Vendor oversight
  • Daily clinical oversight
  • Plan design modeling and recommendations
  • Risk assessment and program development
  • Market pricing checks
  • PBM Contract re-negotiation

The bottom line for clients is our ability to maximize the cost efficiency of their benefit dollars without sacrificing member benefits or service levels.

For additional information, please contact: Mark Whitcher at mwhitcher@ktpadvisors.com or 401.490.9351.