PBM is not a 4-letter word: How an independent PBM and an integrated pharmacy strategy provides value for your organization

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Every dollar counts when you’re serving an underserved population. However, many organizations fail to incorporate a holistic approach to pharmacy and typically will separate pharmacy benefit management from pharmacy operations management. Creating an integrated pharmacy strategy can drive significant value for your organization and improve outcomes for your patients.

Here are three areas where you start to see the value of turning your pharmacy operations into a top performing strategic asset: 

  • Capturing employee prescriptions and leveraging your existing assets.
  • Owning your pharmacies and increasing drug and payor network access.
  • Further establishing yourself as a center of care in your community.

Capture employee prescriptions and leverage your existing assets:

As a health care provider, you are unique—you have employees and pharmacies. Most PBMs treat all their customers the same, whether it’s a logistics company or a hospital. Large, vertically integrated PBMs are often in direct competition with you as your patients’ pharmacy of choice. To improve and expand your services, you need a PBM partner that understands your organization. This partnership can create an opportunity to increase capture rates and align care with your patient clinical programs. 

At Maxor, we are an independent PBM. We recognize your unique assets, and we’ve designed solutions specifically for managing a 340B covered entity’s pharmacy benefits. We can help design your network to prioritize your pharmacies, making it easy and convenient for your employees to fill their prescriptions at your pharmacies, reducing prescription leakage. We create a customizable and adaptable formulary that’s aligned with your purchasing strategy to optimize cost, rebate, and clinical benefits. Our comprehensive analytics tools provide real-time decision support across rebate, GPO (when available) and 340B pricing and provide a detailed record of your 340B purchases that you can use to monitor program compliance.

Own your pharmacies and increase drug and payor network access:

Manufacturer restrictions have had a substantial impact on 340B covered entities by limiting their ability to replenish 340B eligible dispensed products to their contract pharmacy network. To truly maximize your 340B savings, you should consider owning your outpatient and specialty pharmacies, but that transition requires a new set of capabilities, such as gaining access to Limited Distribution Drugs (LDDs) and inclusion in payor networks.  

At Maxor, we help you build and manage your outpatient, inpatient, and specialty pharmacies. This includes staffing your pharmacies, optimizing your 340B program, and improving the lines of communication between your pharmacists and providers. Using our proprietary analytics tool, we can identify areas of uncaptured value across your pharmacy operations down to the drug, payor, or prescriber level. We can then deploy strategies to capture opportunities that enable you to provide more comprehensive care, increase a patient’s speed to medication, and retain patients in your care network.

Further establish yourself as the center of care in your community:

An optimized pharmacy is a strategic asset that delivers clinical and financial value and reaffirms your position as the center of care in your community. An integrated pharmacy strategy can help you offer medications to eligible patients at a reduced cost, capture patients at the point of care, and customize your formulary according to your clinical strategy. The value your pharmacy contributes enables you to reinvest the savings and revenue into your clinical programs that serve your patients and community, improve patient access and the patient experience while maintaining 340B program compliance.

At Maxor, we work with you to develop a cross-functional pharmacy strategy across purchasing, formulary, and prescribing to deliver clinical and financial value. We create an ecosystem of care, with you at the center, by retaining patients and employees within your network, utilizing your owned pharmacies, and appropriately optimizing your 340B and specialty pharmacy opportunities. We help you transform your health center, one prescription at a time.

Flipping the Script: How a community health system transformed a $20 million per year loss to a $10 million gain in one year with an integrated pharmacy strategy

A 340B safety net health system was losing $20 million a year and struggling to maintain compliance across their pharmacy operations. They partnered with Maxor to create an integrated pharmacy strategy so that they could remain the center of care in their community, maintain a high standard of care, and improve and ensure their 340B compliance.

Maxor helped them identify key opportunities for improvement and enhancement:

  • Optimized 340B management, including billing and compliance.
  • Outpatient pharmacy management, including enhancing reimbursement, minimizing drug expenditures, and improving supply chain efficiency and compliance.
  • Employee pharmacy benefit management, including a clinically driven formulary designed to lower the total cost of care and improve member outcomes.

In year one, the organization turned their losses into $10 million of margin, which they re-invested into critical patient care programs, such as local immunization clinics and dedicated entrances and prescription pickup for immuno-compromised patients. Together we also built a comprehensive compliance program that enabled them to maintain 340B program eligibility and successfully pass all subsequent 340B, manufacturer, and supplier audits.

Jason Atlas, Senior Vice President of Pharmacy Operations at Maxor, can be reached at jtatlas@maxor.com.

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