Pharmacy Plan Audits vs. Rx Co-Pay Optimizers
If you’re a medical benefit plan manager and hearing about Rx co-pay optimizers, this article is for you. The question our clients have is, how much can an optimizer save my plan?
Trade media reports are citing a 4-percent overall increase in prescription costs to commercial plans, driven mainly by a rise in utilization during 2020. But also, there have been drug price increases in some categories, most notably oncology and inflammatory conditions. The two factors responsible for drug prices going up are utilization and unit cost. They must be considered together to understand the whole story each year. As the trade media points out, plans often accept increased utilization because well-documented research shows that medications are less expensive than other treatments.
Our Prescription Plan Audits Have Multiple Benefits
Just as medications treat medical conditions more economically than other methods, a prescription plan audit will often save more than it costs. To the surprise of more than a few Rx benefit plan managers, a review of claim payments can turn up hundreds of thousands of dollars in potential savings – a number far higher than the price of the auditing service. For example, your plan likely favors generic drugs over name-brand medications. But without medical claim auditing and ideally continuous monitoring, it’s common for name brands to be prescribed and paid for when high-quality generics are available.
Your members enrolled in high-deductible coverage also can benefit from the plan improvements that auditing and monitoring can bring about. Our mission at TFG Partners is to help you and your pharmaceutical benefits plan ensure that claims are paid for products and services following the plan description. Over time, TPAs can diverge significantly from a plan’s unique features, and when it happens, costs can increase, and service to members can be negatively affected. It’s advantageous to have an independent medical claim auditing firm that’s focused on plan performance and controlling costs.
TFG Pharmacy Plan Audits are Customized to Your Company
Every self-funded plan providing prescription drug coverage has its nuances and details. It’s why everything we do at TFG Partners is customized by the client. We also have a high level of human review and analysis to go along with our secure, industry-leading benefit plan auditing software. Because we’ve audited hundreds of plans with unmatched attention to detail, we’re aware of many opportunities for claim processing improvements and approaches to lowering costs. While we strive to catch and report every error, our services go far beyond flagging the mistakes; we will help improve your plan.
If you’d like to find out more about how we audit your prescription plan to analyze the potential of an Rx co-pay optimizer or any other aspect, someone from our team would be delighted to talk. Not many other benefits auditors can match the caliber of our pharmacy plan audits. Self-funded benefits plans have a lot on the line, and with health care costs of all kinds skyrocketing, reviewing 100-percent of medical claims and monitoring them continuously is a wise investment. It gives you oversight of claim payments and helps you make sure your plan stays on track financially and serves its members’ needs well.
