The healthcare and pharmacy benefit management landscape has changed dramatically in the last few years. Drug costs have exploded due to specialty pharmaceuticals, which now account for roughly 40% of total drug spend. Meanwhile, PBMs have consolidated further, reducing competition and choice. So it’s hard to know if you are getting a good deal – and whether your PBM is doing enough to manage your costs.

Also, increasing Medicare rules, the emergence of health insurance exchanges, and the expansion of Medicaid pose new and more complex regulatory requirements for health plans.Plans that can’t keep up or simply lack bandwidth face increased compliance risks, including monetary penalties.

At The Burchfield Group, we focus on two broad areas:

Pharmacy Benefits Management | Oversight and Audits:

We help employers and health plans with all aspects of pharmacy benefit management: PBM procurement, contracting, benchmarking, negotiation, auditing, and performance monitoring. Our experts come from inside the PBM and health plan industries. So they know exactly where to find and negotiate for the real savings opportunities.

In essence, we help you manage your pharmacy benefits manager or PBM. We’ll enforce the terms of you PBM contract to make sure they deliver on what they promise. We’ll also see to it that you get your fair share of savings opportunities. And we will hold your PBM accountable for results.

Health Plan Compliance | Audits, and Operations:

We help health plans with CMS Medicare Part C and Part D compliance, audits, data validation, and related areas – and take a deep dive into your supporting operations. We help with contracting, management and oversight of your PBM and other downstream vendors as required by CMS. We also offer our health plan clients expert compliance and operations support related to emerging health insurance exchange requirements and audits, Medicaid (including the Medicaid Mega Rule) and 340B contracting.

Some competing niche-consulting firms rely almost exclusively on 1099 contractors. Not at The Burchfield Group. Most of our pharmacy benefit management and health plan regulatory, compliance and operations professionals and auditors are fully dedicated, full-time employees of our firm. The result: Our clients receive a superior level of continuity, predictability and engagement – and cohesive solutions crafted by a closely-knit team.

Maximize Savings, Mitigate Risks and Optimize Effectiveness

We take a data-driven approach and work with you to develop and recommend a pharmacy program that fits your individual plan needs – helping you maximize savings, mitigate financial and regulatory risk, and optimize effectiveness. Contact us to learn more.