Lisa Stamm discusses minimizing pharmacy plan costs. She explains how the pharmaceutical industry presents some of the most complex and expensive costs for companies that sponsor health plans.
The main role of Pharmacy Benefit Managers (PBMs) is to facilitate transactions when a member fills their prescriptions at a pharmacy. There are four traditional ways of how a PBM is compensated. The first method includes adding a cost to every prescription that is processed. The second is rebate retention, which is retaining all the rebates that plans receive when members use their prescription drugs. The third way is by obtaining the part of the co-pay that was higher than the cost of the prescription, and the fourth is in a traditional structure by being a part of the mail order process.
Lisa shares the problems of a traditional model and the benefits of pass through as an alternative, which is when a PBM is given a fixed and controlled administrative fee. She also explains how focused an employer should be on pharmacy rebates, mail-order and the co-pay structure with regards to prescription drug management.
*The views and opinions expressed in the Public Risk Management Association (PRIMA) blogs/podcasts are those of each respective author/speaker. The views and opinions do not necessarily reflect the official policy or position of PRIMA.*
Vice President, Consulting Services, Sherrill Morgan
Summary of Qualifications
Lisa is a graduate of Northern Kentucky University and the University of Cincinnati College of Law. She has been with Sherrill Morgan since 2005 and manages health and welfare benefit plans, particularly in the self-funded arena. As a licensed attorney, she can consult clients regarding applicable state and federal laws regarding health plans. She is also available to answer questions regarding compliance with applicable laws, including federal health care reform, COBRA, ERISA and HIPAA. Lisa is also an expert and featured speaker on regulatory issues, particularly as they relate to health care reform. She has been a member of the Kentucky Bar Association since 1992.
Lisa is the VP of the consulting division. She and her team oversee all self-funded groups. She is the primary contact for regulation, compliance, and health care reform issues and questions. She has an outstanding track record in reducing and maintaining plan costs. Her vast experience makes her invaluable to her clients.
Lisa has been with Sherrill Morgan since 2005, and she has worked with a wide variety of clients in that time including both public and private employers in Ohio, Kentucky, and Tennessee.
You Might Also Be Interested In
Managing Distracted Driving in Law Enforcement (Part 3): Supervision & Accountability
Fleet safety begins with establishing a fleet safety management program that has clear and concise policies and procedures, communicated to all employees, with employees clear understanding of consequences of not meeting the organization’s standards for safe driving. Also, the importance of management consistently modeling expected behaviors cannot be over emphasized.
Using Social Media Effectively for Growth and Transparency
Brian explains how to expand a social media following. While considering communication practices, he compares the usefulness of social media to a town square – they are both offer an opportunity to exchange important information in an area where people will already be congregating.
Managing Distracted Driving in Law Enforcement (Part 2): Policies, Procedures and Programs
A best practice in preparing fleet safety policies and procedures is to consider what steps will be needed to best motivate changes in officer’s driving behavior to better manage distractions arising out of their duties.