Clinical Services Team: Pharmacy Unit

Adjusted $$ Pharmacy Spend (actual spend minus invoiced rebates)

$14.48MilSFQ4 2020

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Notes on Methodology

Partners
  • Change Healthcare
  • Pharmaceutical Manufacturers
Story Behind the Curve

The Pharmacy Unit oversees the rebate programs.  DVHA's Pharmacy Benefit Manager, Change Healthcare, manages the rebate processes. Rebates are invoiced every quarter. The measure shows an estimated net spend because it is based on rebates invoiced, not rebates collected. 

The rebate program is vitally important to DVHA’s overall healthcare spending. DVHA receives approximately 60-65% of its drug spend back in the form of federal, state and supplemental rebates.   

Optimally, we manage drug spend by maximizing rebate opportunities and preferring drugs that have the lowest net cost to DVHA and meet the clinical needs of our members.       

Last updated:  09/15/2020

Strategy

DVHA’s strategies for managing the lowest net cost possible is primarily driven by successful management of our Preferred Drug List (PDL). Through support from our PBM, Change Healthcare, and our Drug Utilization Review Board, DVHA makes informed drug coverage decisions based on clinical appropriateness and the lowest net cost possible. We take into consideration factors such as drug acquisition cost, federal and supplemental rebates, and manage non-preferred products through effective strategies such as prior authorization, quantity limits, and step therapy.

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