Health Benefits Administration: Pharmacy Benefit Services
Provide Convenient, Affordable, Access to Prescription Medications With Pharmacy Benefit Management Services
Using Mayo Clinic's pharmacy expertise, Mayo Clinic Health Solutions helps employers develop benefit designs to provide convenient, affordable access to prescription medications while minimizing costs. Pharmacy Benefit Management is based on the Mayo Clinic Formulary, which is regularly monitored and updated by Mayo Clinic pharmacists and physicians.
Mayo Clinic Health Solutions offers a nationwide network of nearly 50,000 pharmacies, all with point-of-sale electronic claims processing through the services of SXC Health Solutions Inc. A convenient mail-order program is also available through the Mayo Clinic Pharmacy mail-order service. Advantages of our program include:
- High-quality services — We focus on plan members' health by using only drugs reviewed and approved by clinical experts at Mayo Clinic. In addition, SXC uses a sophisticated online patient profile to safeguard members from adverse drug interactions.
- Ease of use — A national network of 50,000 pharmacies, advanced online services and a convenient mail order program make our Pharmacy Benefit Services easy for both clients and employees to use.
- Comprehensive analysis — Quarterly reports provide financial and trend analysis, as well as industry benchmarks, that allow clients to understand how their organizations compare to industry norms.
- Rebate-sharing — Mayo Clinic Health Solutions passes along rebates it receives from the volume discounts of a number of pharmaceutical manufacturers.
- Flexible plan design — Our benefit packages and administrative service rates are among the most competitive in the industry. This helps clients control plan costs while designing a benefit package to fit your organization's unique needs.
Pharmacy benefit plan consulting
Prescription drug prices are a key element of double-digit increases in health care benefit costs. Our qualified team of Pharm.D.s, pharmacy technicians and medical directors offer clients complete pharmacy consulting services with a proven track record of demonstrated client savings. Through customized pharmacy benefit plan design, we support each client’s objectives — both clinically and financially. Pharmacy consulting services consist of:
- A thorough review and analysis of the current pharmacy benefit plan design. Mayo Clinic Health Solutions pharmacists will assess the current plan and identify the key drivers of cost increases for pharmaceuticals. In addition, we will recommend programs that deliver the right mix of cost and utilization management.
- An analysis of pharmacy claims. Our pharmacist consultants will review all pharmacy claims data and analyze cost structures to determine the actual payment configuration of current pharmacy claims and utilization patterns of medications. This information will be used to assess if the current pharmacy plan design is being followed or if there are hidden spreads, network price manipulations, rebate games and/or other fees escalating medication costs for clients. The information will also be used to assist in creating an optimal pharmacy benefit design plan.
- A detailed report of findings and plan design recommendations. Mayo Clinic Health Solutions will prepare and submit a final report based on the plan design of our clients' business and wellness objectives.
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