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MINNEAPOLIS-A Twin Cities health care coalition's new contract for prescription benefit management services is expected to lead to better health care management by providers, which could mean lower costs for employers.
The Buyers Health Care Action Group has entered into a three-year contract with Express Scripts/ValueRx to provide PBM services to the coalition's Choice Plus plan, which directly contracts with providers in the Minneapolis-St. Paul area.
While the Twin Cities coalition of 28 employers had offered its Choice Plus enrollees prescription drugs in the past, this is the first time the BHCAG has separately contracted with a PBM company for those services. Prescription drug benefits currently are offered through the coalition's administrator, Minneapolis-based HealthPartners.
The HealthPartners contract, though, expires at the end of 1999. BHCAG put its administrative services out to bid last August and the HMO did not submit a bid (BI, July 6).
A decision on a new administrator is expected by October.
ESI/VRx will begin offering pharmacy benefits Jan. 1. In addition to such traditional services as a pharmacy network, formulary, rebates and mail order prescription services, ESI/VRx also will provide customized consultation on data analysis, formulary development, disease management support services and medication adherence programs for consumers to each of the provider groups that contracts with BHCAG.
The health care community has closely watched BHCAG since it began offering its employees the Choice Plus program, which now revolves around 17 care systems-groups of physicians and hospitals approved by the coalition to compete for patients based on coverage offered and rates. Under this approach, the coalition contracts directly with provider-based care systems, rather than relying on managed care companies as intermediaries (BI, Dec. 23/30, 1997).
According to Ann Robinow, executive director of care systems and finance for BHCAG, the decision to contract with a PBM was made as an effort to provide the individual care systems with the support and information needed to make the best decisions in managing patient medication and total health care.
Tamra Lair, health care practice leader for Watson Wyatt Worldwide in Minneapolis and the project manager for the coalition, said that "the real emphasis was to get physicians a whole set of tools to manage pharmacy utilization for which they are now at risk."
Plymouth, Minn.-based ESI/VRx is the nation's largest PBM not owned by a pharmaceutical manufacturer. Such combinations have raised conflict-of- interest questions among some purchasers, as well as the federal government.
Ms. Robinow said ESI/VRx's independence was not "the deciding factor" in the coalition's choice, "but it was a plus."
"As an independent, it has the ability to make decisions and provide advice that is unencumbered," she said.