Upload
duongbao
View
214
Download
0
Embed Size (px)
Citation preview
The opinions expressed in this presentation are those of the speaker. The International Societydisclaims responsibility for views expressed and statements made by the program speakers.
Creating a Strategic Pharmacy PPN
Greg Caines, CEBSPartnerMorneau Shepell Ltd.Halifax, Nova Scotia
Confidential – Not for Distribution
2D-1
In today’s session we’ll cover…
• Pharmacy PPN landscape• Plan sponsor objectives• Key elements of the RFP• What to include in the SLA• Implementation considerations• Integration with overall HR strategy
2D-2
Pharmacy PPN Landscape
2D-3
Pharmacy PPN Landscape
• Challenges faced by retail pharmacy:- Generic legislation squeezing profit margins- Scope of practice evolving- Fierce retail competition- PBM agreements - Administrative burdens - Counsel patients, monitor adherence, intervene with physicians, & be a benefit plan expert…
2D-4
Pharmacy PPN Landscape
• Challenges faced by Plan Sponsors:- Low perceived value of benefit plan by employees- Cost management- Employee health and wellness- Drug non‐compliance waste- Rapidly changing drug landscape- Attraction & retention
2D-5
Plan Sponsor Objectives
2D-6
Plan Sponsor Objectives
• Enhance plan/member value• Cost management• Drug formulary design insights• Subject matter expertise for education • Improve health outcomes
2D-7
Pharmacy Objectives
• Increase Rx market share• Drive store traffic…high GM margins• Leverage their expertise to drive new revenue• Improved health outcomes • Customer loyalty
2D-8
Key Elements of the RFP
2D-9
Pre‐work before the RFP
• Mine your data to understand:- Cost & Rx market share by chain in your region(s)- Key Performance Indicators (KPI’s) by pharmacy
› Generic Fill Rates (GFR)› Maintenance Days Supply› Unit costs› Drug mix & therapeutic sub opportunities
- Burden’s of illness/health drivers
2D-10
Key Elements of the RFP
• Financial value• Health management resources/expertise• Reporting capabilities• Internal communication practices• Push strategy versus passive
2D-11
• Consulting pharmacist support• Marketing & implementation support• Distribution network/locations• Other services/programs• Willingness to enter into a SLA
Key Elements of the RFP
2D-12
Financial Value
• Member benefit on prescription costs• Loyalty program details
- Significant discounts on general merchandise- Linkage with existing retail loyalty program
• Partnerships with other rewards programs
2D-13
Health Management Resources
• Health Risk Assessment tools (HRA’s)• Biometric screening
- Scope - Location(s)
• Medication management reviews• Compliance programs
2D-14
Health Management Resources
• Nutritionist/Dietician• Health Coaching• Lunch ‘n Learns• Web tools for drug/disease information
2D-15
Reporting capabilities
• Tracking financial savings- Prescription benefits- Loyalty program benefits
• KPI’s• Health Management activities
2D-16
Internal Communication Practices
• How do they communicate with their pharmacy staff?
• How often?• How will the staff be made aware of the preferred client arrangement?
2D-17
Push Strategy versus Passive
• Traditional model customer initiated• Proposed model pharmacist driven
- HRA- Biometric Screening- Medication Management Reviews- Dietician/Nutrition Counseling- Health Coaching
2D-18
Push Strategy versus Passive
• Targeted health outreach programs - Diabetes- Mental Health- Heart Health- Digestive Health- Respiratory Health
2D-19
Consulting Pharmacist Support
• Insights on drug formulary design- Optimal tiered approaches
• Education- Generic drugs- Specialty & biologic medications- Counter‐detailing clinics
2D-20
Consulting Pharmacist Support
• Developing pilot initiatives for:- Trial Rx- Adherence management programs- Therapeutic substitution
2D-21
Marketing & Implementation Support
• Marketing Support:- Member brochures- Wallet id cards - Kitting packages and distribution process- Ability to tailor/brand- On‐site promotion/member information sessions
2D-22
Marketing & Implementation Support
• Established process for implementation- Managing member eligibility
› Initial load› Updates
- Internal coordinator/support
2D-23
Distribution Network
• Market penetration/locations relative to employee/work locations
• Potential for alliances where geographic penetration sub‐optimal
• Mail order services
2D-24
Other Services/Programs
• Medical equipment• Home health care
2D-25
The Service Level Agreement
• Will they enter into an agreement?• Sample of their standard contract• Schedule of performance objectives• Terms & Conditions • Length of agreement 3+3
2D-26
Implementation Considerations
2D-27
Implementation Considerations
• Baseline your KPI’s prior to launch• Full enrollment versus voluntary• Ensure privacy and confidentiality language protects - Sponsor’s data- Member’s will not be mass marketed to- Obtain consent for targeted health management
• Cover letter in kit from Plan Sponsor• Union/affinity groups
2D-28
Integration with Overall HR Strategy
2D-29
Integration with HR & Benefits Strategy
• Incorporate into overall tools inventory• Align services with priority “pain points” from baseline data
• Ensure PPN team understands your culture/goals/objectives/programs so they can champion your brand
2D-30