NEWS & ANNOUNCEMENTS
Labor/Management Newsletter
June (2nd Quarter) 2010
Labor/Management Newsletter
January 2010
LMHCC 10th Annual Meeting
February 12th, 2010
Endorsement of Epic Hearing Health Care
Accessing Low Cost Prescriptions without Prescription Benefits
Endorsement of National ReClaim, Inc.
Pharmaceutical Industry Copayment Programs
Labor/Management Newsletter
August 2009
Average Wholesale Price Update
Evergreen Rx Newsletter
June 2009
Evergreen RX
Who is Evergreen Rx?
Evergreen Rx is a consulting practice based in Minneapolis that specializes in securing optimal prescription benefit pricing options for its customers. Our experience includes pharmacists and 25+ years of work experience across multiple healthcare businesses. Evergreen Rx knows how the system works, and when it doesnt. We negotiate the contracts with the various administrators of benefits and also advise our clients on market changes, both through regulatory rulings and competitive factors, to insure our clients interests are being served. Evergreen Rx is not a broker and we do not receive any fees from big business. Our only incentive and compensation comes from the clients we serve; this keeps our agenda aligned with the LMHCC objectives.
Why does LMHCC contract with Evergreen Rx?
Pricing prescriptions and the entire industry of providing a drug benefit is complicated by many private entities. Pharmaceutical manufacturers, pharmacies, PBMs and insurance companies all have unique vested interests to maximize their profit, often on the back of the individual consumers. Evergreen Rx clearly understands each of these stakeholders interests, the current market offerings of each and how the cash flows through their hands. By contracting with Evergreen Rx, LMHCC is able to see through the maze of hard sells and quickly identify the too good to be true offers. Evergreen Rx continuously works with the PBMs that offer prescription benefits to LMHCC members to update contract terms and deliverables as the environment changes. This is occurring more frequently; we historically witnessed contracts that could last 3 years with little modification. Now, they need to be update annually at minimum, sometimes 2-3 times a year based on new regulatory requirements.
Why use the LMHCC prescription benefit options?
There are two primary reasons for using the LMHCC for prescription benefits. First, any contracts whether healthcare or labor negotiations, are driven by negotiating leverage. The more members on your side, the more leverage, hence the better pricing that can be achieved. The large healthcare businesses have become large by keeping the individual funds, employers etc. fragmented. Its a divide and conquer approach. The strength in numbers approach brings substantial value to individual funds. Second, by participating with the LMHCC, a smaller fund can get pricing andcontractual privileges that it could not attain on its own. Using LMHCC assures a fund has access to a best in class prescription benefit contract, which not only meets regulatory obligations; it also is constantly updated to meet competitive market changes. Evergreen Rx keeps the contracted third parties on their toes.
What services does Evergreen Rx offer through LMHCC?
There are dozens, if not hundreds, of items to consider when selecting a prescription benefit program. Evergreen Rx understands all of the ambiguities, which lead to extra fund expenses. Although a pricing exercise is helpful in making a decision, it is often the terms and condition of a contract that truly drive the total cost to a fund. Evergreen Rx has witnessed many proposals that appear attractive, however once the fine print uncovers how various guarantees are tabulated, the financial headlines look less attractive. It is truly a buyer beware marketplace.
Prescription Benefit Services available to LMHCC members include:
- Evaluation of a fund’s prescription benefit performance
- Contrasting current performance to the multiple LMHCC offerings through both CVS/Caremark and Catalyst Rx
- Discussion on the pros/cons of multiple terms, including but not limited to ownership and use of data, multiple disclosure requirements by PBMs, influence on distribution channels (mail vs. retail), specialty pharmaceutical management
- Benefit design consultation, including cost and disruption examination, industry comparisons and preparation for future cost drivers
- Clinical program consultation, including communications and incentives to drive lower cost and clinically appropriate therapies
- Impact of the March 2009 prescription price rulings (AWP) and the impacts of proposed government reforms
- Plus, most any other topic in the prescription benefits industry…
What recent activities are being performed for LMHCC funds?
The prescription benefit management marketplace changes constantly and as such Evergreen Rx is always working to improve pricing and contract terms for LMHCC members. At present the following negotiations are underway.
- Catalyst Rx - improvement in rebate dollars per brand drug for both 2-tier and 3-tier prescription benefit designs
- CVS/Caremark – improvement in pass through pricing to competitively assess transparent offer to funds
