Many different components must come together for a pharmacy to be run successfully. One of those critical components is pharmacy benefits management, a topic discussed in this blog.

Pharmacy benefits management (PBM) is a critical function in the healthcare industry, responsible for managing prescription drug costs and ensuring that patients have access to the medications they need. Through efficient PBM, pharmacies can run smoothly and provide a quality patient experience. Focusing on PBM is one of the best ways to ensure productivity and improve patient retention rates.

The PBM industry is constantly evolving, with even more changes being made in recent years. Various factors drive this evolution, including the rise of value-based care, the increasing cost of prescription drugs, and the growing demand for patient-centered care. Considering these factors is essential when discussing the PBM industry, as they play a significant role in healthcare.

With more and more change occurring in the PBM industry, companies are looking for new ways to drive innovation and improve their services. Outsourcing is one of the best ways to do both of these things.

The Role of BPO in PBM

Business process outsourcing (BPO) is a helpful tool many businesses use to maintain their current workload and free up room for professional growth. Interestingly, BPO can play a crucial role in driving innovation in PBM.

Outsourcing Services

There are a variety of different services that PBMs outsource. Which services are right for your business to outsource will depend on various factors, such as your current workload, the demands presently on your in-house team, and your budget. Consider the following services and whether outsourcing them could be the right choice for your pharmacy

• Claims Processing : Claim processing must be done efficiently and promptly, so outsourcing this task makes so much sense. Through productive claims processing, patients can get the answers they need and access essential medications.

  When searching through different PBM providers, finding ones with specialized experience in the areas you're looking to outsource is essential. For example, finding a provider that understands how to evaluate and analyze claims is necessary so you don't have to provide extensive training.

• Drug Utilization : Review Medications must be used appropriately and safely, where drug utilization reviews come in. Doing reviews can easily take up your in-house team's time, so outsourcing is an excellent option. By conducting regular inspections, you can provide a quality patient experience and ensure that all patient care team members are on the same page about their medications.

  When doing drug utilization reviews, sometimes it's necessary to coordinate with physicians. This is one of the primary services that we offer at Everise. Patients can receive the proper medications at the best cost through quality physician coordination. From prior authorization to managing refill timing, we provide comprehensive services in this area, meaning you can focus on other aspects of your pharmacy.

• Formulary Management : empowers all care team members to equip patients with optimal medications at the correct cost. Formulary management can require a high level of communication and coordination - making it an excellent work area to outsource.

  Through effective formulary management, patients can receive appropriate medications within their budgets. Outsourcing this task will mean that your in-house team can focus on more specialized jobs and that your patients can access needed medications.

• Patient Compliance : essential in ensuring that medications are taken safely and as prescribed. Managing patient compliance requires a high level of personal knowledge about various drugs and pharmaceutical principles, so it's best if a professional handles this area of work.

  At Everise, we specialize in member engagement. By doing this, we provide customers with a quality experience and help pharmacies operate appropriately within guidelines and regulations. Member engagement includes a variety of things, such as medication adherence.

  Medication adherence is a pillar of what we do, ensuring that patients understand their pharmaceutical instructions and can comply. If your pharmacy is struggling in this area, consider whether Everise services could be the solution.

  Some of our services include:
  - Tactics for remembering to take medications
  - Ensuring adequate medication quantity before traveling
  - Educating about the importance of maintaining a consistent schedule
  - Practical strategies to manage complex medication routines

• Data Analytics : Analyzing data is about more than looking at a sheet of numbers. It means pulling real-world applications from the data, offering suggestions, and finding areas for potential improvement. Being able to analyze data effectively can set your pharmacy apart from competitors, so it's an essential area of work to consider.

Outsourcing PBM

By outsourcing the previous services to a BPO provider, PBMs can free up their resources to focus on other areas. Many in-house teams outsource specific tasks, develop new products and services, improve customer service, and manage risk.

Outsourcing PBM is an excellent way to delegate tasks and ensure that your in-house team has enough time to complete their specialized functions.

The Benefits of BPO for PBMs

There are a wide variety of reasons why many pharmacies choose to use a BPO provider for their PBM. Let’s go over a few benefits you can expect when choosing the right outsourcing partner…

Cost Savings

BPO providers can often offer PBMs significant cost savings on various services. Outsourcing may cost you money but could also save you money in areas you didn't anticipate. Another way that outsourcing can save you money is through increased efficiency.

Increased Efficiency

Working with the right BPO provider means you'll have access to an experienced team that can complete tasks productively and efficiently.

Saving time means saving money, so taking advantage of experienced staff can mean things get done faster, and new processes are implemented to boost productivity. Being able to rely on the expertise of an outsourced team can benefit multiple areas of your business, so consider if it could be the right choice for you.

Enhanced Compliance

Especially within the pharmaceutical industry, compliance is a complicated topic. The rules and regulations are constantly evolving, so it's essential to have team members dedicated to this area of work. By outsourcing, you can be sure that your pharmacy remains compliant and operates legally.

One of the best parts about outsourcing this work area is that you won’t have to provide intensive training - the BPO team will already be updated on current regulations and can start working immediately.

Improved Focus

One of the best reasons to outsource is that it can improve your in-house team's work life and productivity. By outsourcing non-core functions, PBMs can free up their resources to focus on core competencies.

Being able to rely on your in-house team for specialized functions is essential; outsourcing can make that a reality. When you choose to start outsourcing, it’s necessary to ensure that everyone knows their various roles and that job definitions are clear.

One of the best reasons to outsource is that it can improve your in-house team's work life and productivity. By outsourcing non-core functions, PBMs can free up their resources to focus on core competencies. Being able to rely on your in-house team for specialized functions is essential; outsourcing can make that a reality. When you choose to start outsourcing, it’s necessary to ensure that everyone knows their various roles and that job definitions are clear.

From Compliance to Efficiency

There are so many ways in which outsourcing PBM makes sense for most pharmacies. Thoughtfully outsourcing various tasks can drive innovation and improve your pharmacy’s services. Not only that, but outsourcing can save you money and time through increased efficiency and enhanced compliance.

As the PBM industry evolves and changes, BPO will likely play an even more significant role in helping PBMs meet future challenges. Contact our Everise team today to learn more about our outsourcing options and decide if they could be the right choice for your pharmacy.