The Power of Good Neighbor Pharmacy
Generic Effective Rate (GER) and Brand Effective Rate (BER) contracts have continued to be a major pain point for many independent pharmacies throughout the COVID-19 pandemic. These effective rate agreements can result in devastating PBM clawbacks, but Elevate Provider Network has a very distinct strategy when it comes to GER/BER arrangements that offers protection for our member pharmacies. Through proven mitigation strategies, we help reduce or even eliminate these recoupments so you can maximize your profit margin — all while paving a sustainable path for profitable growth.
First, we avoid these agreements whenever possible. For example, Elevate Provider Network chose not to participate in the Express Scripts “Preferred PSAO” model. By being directly contracted with Express Scripts, our members are not subject to the Express Scripts GER, saving the average Elevate member tens of thousands of dollars each year.
Second, when we can’t avoid these agreements, we delay them as long as possible. This is the tactic we took when we prolonged the implementation of the OptumRx BER/GER. While many PSAOs eagerly signed the initial agreement with OptumRx in 2018, we continued negotiations for almost a full year. As a result, our members were not subject to the OptumRx BER/GER until 2019, saving our network hundreds of thousands of dollars.
Finally, when we can no longer avoid or delay, we meticulously manage the BER/GER process with the PBM to make sure our pharmacies pay the least amount possible under the terms of the contract. We don’t simply accept the first overpayment demand presented by the PBMs. Our dedicated contracting team negotiates relentlessly for every dollar because we know it’s your profitability that’s on the line. Every dollar we can save you is one more valuable dollar you can reinvest back into your pharmacy and your community as you continue to navigate the pandemic together, so we fight like the stakes couldn’t be higher.
During our reconciliation with OptumRx for 2019, Elevate Provider Network went through a long, arduous process to ensure our members weren’t paying a dime more than they had to, and it resulted in the aggregate recoupment amount being less than 25% of OptumRx’s initial demand for overpayment. Similarly, we were able to eliminate the Caremark recoupment for 2019 despite initially receiving a demand for overpayment.
Elevate Provider Network is constantly working behind the scenes to protect the financial health of your pharmacy, and our data-driven strategy around GER and BER is one of the most crucial ways we contribute to your bottom line.