Pharmacy

Circle Pharmacy Pool delivers the best results available.

Circle Pharmacy Pool delivers the best results available by achieving the lowest total cost for prescription drugs.This includes a coordinated, patient focused specialty pharmacy approach and outstanding clinical care programs. And the results are guaranteed.

"The drop in pharmacy expense (a 23% reduction) was solely the result of changing providers."
"The Pharmacy Replay substantiated their claims - the tool demonstrated a savings of 11%"

Why Choose Circle Pharmacy Pool?

• Demonstrable Value through our Claims Replay Analysis
• Guaranteed Results
• Formulary design to achieve lowest total costs
• Consistently lower trend than the major competitors
• 30 million member network
• Over 60 thousand participating pharmacies

Ask us to perform a Replay Analysis to compare savings between us and your current pharmacy benefit manager.

Pharmacy
It's What You Buy

How much your plan spends on drugs depends primarily on what drugs are purchased. The Claims Replay analysis anticipates what drugs will be dispensed, and how much your plan will pay for them.

Focus on the lowest cost

Why should I care about the Lowest Total Cost? Most human resource managers and insurance advisors will privately admit to frustration with pharmacy analysis. They know they aren't being told the whole story. There is good reason for feeling that way: they aren't being told the whole story!

Imagine buying a car on the sole basis of saving a big percentage of the asking price, without knowing the sticker price, or even what kind of car it is. It sounds unimaginable, but you do it every day with your pharmacy plan!

Don't believe it? Did you make your buying decision based upon:

  • The best "AWP minus" deal offered?
  • Perhaps the lowest administration fee?
  • Was it zero, and did you believe that?
  • The highest rebate to your plan?
  • Where do you think those dollars come from?

What really matters is the total cost you end up paying, not what discount you received.

Replay Summary Results

Through our Claims Replay analysis, we will show you what we expect your claims cost will be next year for your plan. Bottom line, no double talk. Then, we put our money where our mouth is. We guarantee what your costs will be. Who else does that for you? Does your current PBM? Contact us today for your Claims Replay.

Other PBMs will try to sell you with the idea of "repricing" claims as a means of comparison. The Claim Replay is a much more accurate picture than the method of "repricing" which anticipates no drug change whatsoever.

This method of evaluating prescription plan costs has been validated by a nationally recognized actuarial firm. Copies of their report are available upon request. Contact us for your own Claims Replay analysis to see how much your plan will save. We will show you, and we will guarantee it!

How Do We achieve lower costs than our competitors?

It's simple: we promote lower cost approaches that save you money. Why don't other PBMs follow the same approach? It's simple: our approach costs them money. Here's an example: does your current formulary include Nexium as a preferred brand? Take a look at the chemical difference diagram:

The truth is that certain drugs generate a lot of money for certain PBMs in many ways. The question is: who are the looking out for; you or their own pocketbook? Also consider this:

  • AHRQ Releases First Comparative Effectiveness Review; Certain Drugs Found as Effective as Surgery for Management of GERD, December 14, 2005
    • PPIs apper to have similar clinical effectiveness when compared to one another for treating GERD. Some statistically significant differences have been reported, but these differences are modest and the clinical implications are unclear. Example of PPIs include Aciphex®, Nexium®, Prevacid®, Priloces OTC®, and Protonix®. Generic omeprazole is also available.

  • Consumer Reports advocates Prilosec OTC as the most cost-effective therapy for heartburn and acid reflux, January 23, 2007
    • Although the five treatments available to treat heartburn and acid reflux desease appear to be equally effective, AstraZeneca Plc's Prilocex OTC (omeprazole) may cost 10 times less than the other prescription drugs in its class, according to Consumer Reports.
    • As part of the Consumer Reports Best Buy Drugs public education program, physicians and researchers at the Oregon health &Science University Evidence-Based Practive Center conducted an independent scientific review of hundres of clinical studies on proton pump inhibitors.

Isn't it about time to use a pharmacy arrangement that looks out for you?

Contact us today for a Claims Replay analysis to learn how much you will save.

What should we be watching for in the pharmacy market?

What should we be watching for in the pharmacy market? Many employers prefer “no disruption” to their health plan. That means no provider changes in the PPO, no changes to the drugs on “the list”, etc. This is simply not going to happen. No matter how much you dislike it, the market is changing around you.

The list of available drugs in the market is constantly changing. Even if a plan wanted to stand still with no change, they would be unable to because of these facts:

  • More drugs are becoming available as generic
  • Specialty drugs are becoming more widely used for multiple conditions
  • Bilogics are a costly trend that must be effectively managed, and they create strong ethical questions that demand judgement.

You need to plan for “good disruption” and the right changes to your plan.

Consider this:
The chart reveals the generics likely to become available during these two years. You must decide how your plan will cover them, or if they will cover them. Generally speaking, this can mean lower cost to your plan. But not if you are with a PBM that is not promoting lower cost alternatives—and there is a good chance you are spending too much money now!

Contact us for a Claims Replay today to see how much you will save.

Trend Management

Saving our clients the most money on their prescription drugs means effectively managing costs. Our Claims Replay will show you the difference in our costs versus your current program. Another way to measure the efficacy of our approach is to see how our plan has performed over time. Consider the National Trend diagram:

We are simply doing a better job. Why isn't your current PBM performing at this level? How do we manage to do this? Here are some of the ways:

For example, many PBMs, when pushed, will "allow" you to include cheaper, over the counter drugs in your plan. We suggest including Over The Counter drugs, and promote their use heavily with your participants. And, we get results.
Why doesn't your PBM? Because it costs them money to do so! Who are they looking out for--you, or them?

Contact us today to see how we will help you promote the best ideas for your plan.

Lowest Total Cost

Why should I care about the Lowest Total Cost?
Most human resource managers and insurance advisors will privately admit to frustration with pharmacy analysis. They know they aren't being told the whole story. There is good reason for feeling that way: they aren't being told the whole story!

  • Imagine buying a car on the sole basis of saving a big percentage of the asking price, without knowing the sticker price, or even what kind of car it is. It sounds unimaginable, but you do it every day with your pharmacy plan!
  • Don't believe it? Did you make your buying decision based upon:
  • The best "AWP minus" deal offered?
  • Perhaps the lowest administration fee?
  • The highest rebate to your plan?
  • Where do you think those dollars come from?

What really matters is the total cost you end up paying, not what discount you received.

Through our Claims Replay analysis, we will show you what we expect your claims cost will be next year for your plan. Bottom line, no double talk. Then, we put our money where our mouth is. We guarantee what your costs will be.
Who else does that for you? Does your current PBM? Contact us today for your Claims Replay.