CHICAGO, May 28, 2015 /PRNewswire/ -- The recent flurry of PBM mergers and acquisitions has left health plans and employer groups scrambling to identify a pharmacy benefit manager that isn't owned by a major managed care plan, retail pharmacy chain, or other potentially conflicting entity.
United Healthcare's $13.3 billion purchase of Catamaran, Rite Aid's $2 billion acquisition of EnvisionRx, and CVS's recent announcement to purchase Omni-Care for $10 billion are just the latest examples of the attempts to consolidate pharmacy and ancillary healthcare services into carved-in PBM offerings. And while that might be good for Wall Street, it's a concern for Main Street, as these types of acquisitions often can shift a company's focus and resources from client to buyer.
For employer groups, the timing could not be worse. Aside from the operational stops and platform integration delays that often accompany PBM merger activity, managed care plans and employer groups often rely on PBM consultants who are either unaware or unwilling to seek out pharmacy benefit solutions that aren't the familiar "Big Box" PBMs they've endlessly settled on over the years.
Equally challenging is identifying a stand-alone pharmacy benefit manager that isn't "virtual" and has the experience and capacity to service diverse clients with complicated pharmacy management needs.
But there IS a solution.
Chicago-based Citizens Rx, LLC is a full-service Pharmacy Benefit Management provider for health plans and public and private employer groups in the US and Puerto Rico.
Citizens Rx provides "unbundled," modular pharmacy benefit management services, including formulary management, claims processing, mail and specialty pharmacy services, and a 67,000-location national pharmacy network.
"Managed Care plans and employer groups are facing unprecedented challenges in their efforts to control rising pharmacy costs—particularly the emergence of high-cost hepatitis C and other specialty drugs," said John Burns, Citizens Rx's Founder and Chief Executive Officer. "Unlike our competitors, Citizens Rx offers our clients the ability to utilize individual PBM services to surgically target specific pain points within their pharmacy spend – be it our pharmacy network, claims processing platform, mail and specialty pharmacy facilities, or PharmAssist—our clinical mobile application."
Client needs differ, and solutions are not unilateral, Burns added. All of which requires a different approach—one that is pro-active, technology and data-driven, yet consumer friendly.
Key to controlling rising drug pharmacy expenditures is working with a PBM that is willing—and able—to provide solutions specific to the client's needs in a direct, customized manner – something PBMs historically have been reluctant to do. Particularly in the area of Specialty Drugs, a growing concern for employer group and health plans nationwide.
Specialty Drugs account for as much as 30% of overall drug spend, even though it only represents two to four percent of member utilization, said Bill Bailey, R.Ph, President of Citizens Rx Mail and Specialty Pharmacy Operations.
"If you really want to control specialty spend, you must invest in technology to better manage the patient," Mr. Bailey said. "Our proprietary mobile application is HIPAA compliant, utilizes location-based technology in real time, and works in conjunction with our pharmacy network and plan design to improve patient assessment 24/7."
"Better patient management equals improved outcomes and adherence, which ultimately controls and reduces pharmacy and medical costs," Mr. Bailey said.
Other programs offered by Citizens Rx include a comprehensive 340B pharmacy solution for managed Medicaid providers, a Fraud Waste and Abuse Specialty Drug program identifying overprescribing and duplicate medical/pharmacy claims, and a comprehensive Medicare Part D program that will go live beginning January 2016.
Citizens Rx has locations in Los Angeles, New York, Tampa and St. Louis.
SOURCE Citizens Rx