Pharmacy Carve Out Programs

Posted On: April 4, 2018 | By: Abigail Cutler

Pharmaceutical related costs make up a third of all health care costs. Naturally, many employers are now looking for creative solutions to help curb these costs and gain transparency to identify savings.

Axion has developed partnerships with companies that can provide a solution for this: Pharmacy Carve Out Programs. A pharmacy carve out program is a risk management strategy where a health care sponsor selects a Pharmacy Benefit Manager to administer and manage its prescription benefit. By using PBMs as a separate claims administrator from the employer’s health insurer, it removes the health plan as an intermediary for pharmacy benefits. Also, stand-alone PBMs can provide a more customized plan design strategy than the embedded pharmacy plans offered by their health insurer.

Furthermore, the standard language in the PBM contract allows for increased transparency by allowing access to pharmacy data, and potential for pharmacy claim audits. Employers can select from several different PBM vendors to find the best choice based on their pharmacy claims history. Studies show that a pharmacy care out plan can reduce pharmacy trend by as much as 50%.

By actively managing pharmaceutical costs and gaining access to critical data, Axion is better equipped to understand the rising costs that employers face and offer meaningful solutions to generate savings with minimal impact to employees.