Laying the Foundation for an Innovative 2024 in Pharmacy Benefit Management

Reflecting on 2023

As we look back on 2023, the pharmacy benefit market experienced dramatic changes. With the launch of Humira biosimilars to the market, GLP-1 products, updates to insulin pricing for 2024, and transforming views on transparency across the industry, it has been a year for change. At MaxorPlus, our foundation continues to focus on transparency, to reduce ambiguity, and to foster trust. We continue to innovate to get our members and clients the lowest net cost by drug class, and that philosophy holds true as we continue into 2024, navigating these industry changes.

Redefining Benefits in 2024

Our clinical teams continue surveying the pharmacy landscape, adjusting our formulary to reduce costs for our members and clients while maintaining a low member impact. For our January 2024 formulary updates, we have less than 0.5% overall member impact while still improving the financial value for our clients. Our team also continues to be flexible; we partner with multiple companies for solutions related to data integration, weight management solutions, and member engagement.

As we look toward 2024, we will continue to make healthcare more affordable for our members. One out of every four Americans has trouble paying for their medications¹. It is important for us as an organization to continue supporting our members in multiple ways. When we think about the pharmacy ecosystem, we have seen price increases across the board: brands, generics, biosimilars, specialty, and non-specialty. Our innovative clinical programs helped lower spending for our clients by $15 per member per month and reduced out-of-pocket costs for our members by up to $115 annually per member².

Fostering Value: Member and Client-Focused Initiatives

Here’s how we’re approaching improving affordability for members as we continue to deliver premium services for our clients:

1. Formulary – The formulary is an effective tool to help direct utilization toward generic drugs, which now account for 90% of utilization today. 
   
2. Benefit design – Not every plan requires a $0 copay design, but there are effective ways to design your benefit to reduce costs and improve utilization, particularly for generic products.
   
3. Patient financial support – These programs provide enhanced member affordability, our specialty pharmacy in particular helps members with affordability issues and provides them with access to manufacturer assistance or need-based assistance programs.
   
4. Pass-through rebates – A key component of our business model that is available to our clients is the option to elect pass-through arrangements.
   
5. Enhanced clinical programs – Our Care Improvement Program leverages our pharmacists’ clinical skills to provide individualized interventions for members in multiple areas using both pharmacy and medical data.

While the challenges evolve each year, our solutions and clinical programs continue to focus on creating real value for our clients by reducing spending, driving member engagement, and promoting transparency in healthcare. 

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Sources

1. KFF Health Tracking Poll, 2020. https://bit.ly/48loNFc. Accessed on 12/4/2023.
2. MaxorPlus Clinical Analytics, 2023.