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  • Writer's pictureRxSense Marketing

Top 5 Qs: Insourcing Simplified

Updated: Aug 31, 2023

The single biggest challenge that organizations have with insourcing is overcoming their biases of the past. Insourcing used to be hard, resource intensive, and costly. But now, with RxIQ® Enterprise, not only is insourcing easier than you think, you can get to market faster than ever with the pharmacy ecosystem that you define. RxIQ Enterprise didn't just change the game — it transformed the entire industry.

Define your own pharmacy ecosystem

Here are the Top 5 questions we are often asked:

How many claims do I need in my program to even consider becoming my own PBM?

We recommend a starting point of around 100,000 claims (which is around 10,000 lives including dependents) for organizations such as Health Systems to consider becoming their own PBM.

There is a misconception that an organization needs a substantial claims count to even consider insourcing. This is simply not the case. RxSense's innovative model gives you all of the advantages of becoming your own PBM — all at your own pace.

How many additional staff hires are necessary to insource my PBM strategy?

No additional staff are needed because we can do everything or anything for you. Only if and when you want, we can assist with any gaps you may have — but only as you see fit, and always at your own pace. While you really only need a primary point of contact to help run the PBM, most organizations simply share the additional responsibilities across existing assets, as needed.

What level of control over my own PBM will I have?

RxSense is not a PBM — we're a PBM enabler. This means that you have final say on how you want your program to operate. It's your business so you define your pharmacy ecosystem. Our model is specifically designed to support you, as needed, to enable your success — from set-up through stand-up, and to help you level-up.

What are the advantages of becoming my own PBM through RxSense?

Organizations with their own assets, such as health systems and grocers, across the nation are increasingly understanding the advantages of insourcing their PBM strategy — ultimate control over their pharmacy program; revenue through driving volume into their dispensing channels (retail, specialty, and mail); and finally having the ability to get truly transparent access into their pharmacy program through direct access to the platform with real-time business intelligence.

Leverage your own assets

Here are just a few of the many reasons they are considering this model:

  • Owning the revenue generated through your program, previously given to your traditional PBM offering — all the while, only taking on the responsibilities that fit the needs of your organization.

  • Leveraging your otherwise underutilized, internal dispensing channels to their full potential by driving volume to produce new revenue.

  • Controlling all parts of your pharmacy program, such as customizing your formulary, implementing the internal clinical programs, adding other external partners as needed, and more. As your own PBM with direct access to the platform, you now have the clearest transparency into your program. What could be more transparent than being the PBM itself?

  • Selling your PBM offering into your local market where you already have a strong brand presence and local employer relationships.

After standing up my program, how does RxSense help me manage my business?

We provide our clients with PBM Business Management & Growth Tools built right into RxIQ | Business Intelligence to help grow and manage their business, not just stand it up. These modules are a unique set of assets for managing your PBM financial operations and performance, ready to go for clients who may have their own network contracts. Elements included in this are our Reprice Expediter tool, Standardized Dashboards and Reporting for things such as Contracts, Financial Guarantee Trackers, and Pharmacy Network Performance Trackers. What's more, we even help our clients with sales and RFP support. Our goal is to help you in all the ways you need, and only in the ways you want.

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