In short, employers should be asking about clinical programs, utilization management and programs that provide value-added services. Strong clinically focused pharmacy programs will offer:

Responsive, proactive client and customer service
Care management to help employees with serious illnesses
Targeted disease management programs that include education aimed at the employees' specific needs
Innovative benefit designs to encourage generic utilization and provide affordable coverage for high-cost specialty pharmacy (also known as injectable or biotech) drugs
Mail service, to help employees save more money

To avoid focusing on cost alone, here are some questions employers can ask that will help to ensure they are getting the maximum value from their pharmacy programs:

What types of clinical programs does the pharmacy programoffer?
Does the pharmacy programhave a track record within clinical programs to show outcomes and return on investment? What is the pharmacy program's experience in maximizing the use of generics?
Is the pharmacy program willing to be audited annually?
Can the pharmacy program demonstrate they are providing the plan sponsor appropriate disclosure?

The primary goal of any pharmacy plan should not be simply to lower cost. An emphasis on cost alone can lead to higher medical costs, poor outcomes and a pharmacy benefit that provides little real value. Only by focusing on the complete array of components that comprise an effective pharmacy benefit program, can employers ensure they secure the best cost and the best value.

Instant Insights /

How to get the most value from your pharmacy benefit plan

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