Health Plan Market Drivers

Health plans are under increasing pressure to improve consumer health and lower costs in order to stay competitive in the marketplace. To do this, they are looking for ways to better control their pharmacy spend while improving the effectiveness of clinical programs offered to members. The trend toward in-sourcing in this growing market is a result of their need to take back control of their pharmacy offering. Health plans need a partner that will support the implementation of defined cost-containment strategies and clinical programs to meet their unique goals.

Today, many health plan clients feel that the traditional PBM business model is not flexible enough to meet their needs. For example, instead of a formulary developed purely to maximize rebates, one customer felt that they could shift pharmaceutical market share through plan design and education. Their new, low net-cost formulary, would allow them to have a lower overall net drug cost. The challenge was finding a partner to help them meet this; a role for which SXC is ideally suited.

We deliver the ability to take back control of pharmacy offerings

SXC recognizes the need for health plans to control their pharmacy offering. For the large plans that currently have a staff of pharmacists and pharmacy benefit experts, SXC offers the licensed tools and technology which enable them to increase their in-house capabilities. For mid-sized health plans, that may have fewer internal resources, SXC offers an ASP model.
SXC’s products and services for health plans include:
     Pharmacy Benefit Administration
     Network Management
     Rebate/Formulary Administration
     Pharmacy/Member Help Desk
     Financial Management
     Member Communication
     Clinical Programs
          -Retrospective Drug Utilization Review (DUR)
          -Prospective DUR
          -Prior Authorization

SXC gives its health plan customers choices for a scalable solution. With these solutions in place, clients have the capability and flexibility to implement their own unique cost-containment strategies and clinical programs. For our ASP clients, we even offer a pathway to ownership allowing them to in-source on a gradual basis.