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A Walmart Low Price Network White Paper

Access Based Network Design

A new approach to significantly reducing prescription drug benefit costs.

Payers and their benefit consultants and PBMs are continually seeking ways to bend the cost curve on prescription drug spending. There has been some success in this area as plan and formulary designs have increased the use of generic drugs and the introduction of $4 prescription drug programs put downward pressure on costs. But it’s not enough. New ways of combating rising costs are desperately needed and CFOs are pressuring Benefit Directors to find ways to rein in health care spending while still ensuring that employees receive the care they need. Access Based Network Design will play a major role in controlling these costs. It doesn’t just slow the cost increases, it actually creates a break in the cost curve and slows future cost increases by applying downward pressure on cost drivers.

Rx Costs

Savings Cost

Rx Costs with Access Based Network Design

Pillars of Access Based Network Design Access Based Network Design is a process of structuring pharmacy networks in which the goal is to minimize costs while achieving predetermined access standards. Most payers are unknowingly operating under a different goal of maximize access at any cost. Access Based Network Design is based on three pillars. 1. 2. 3. Leverage supply and demand to create competition among pharmacy providers resulting in lower costs. Use a ‘bottom-up’ rather than ‘top-down’ approach to network design by building a network based on the number of pharmacies you need rather than the number of pharmacies there are. Provide financial incentives to plan members to offset any disruption or inconvenience created by network changes.

Access Based Network Design

Let’s address each of these pillars separately.

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A Walmart Low Price Network White Paper

Access Based Network Design

A new approach to significantly reducing prescription drug...