The challenge

Many health systems use internal pharmacy resources, such as in-house specialty or mail-order pharmacies, to lower employee pharmacy benefit costs. This can improve employees’ satisfaction with pharmacy care and care outcomes. However, some health systems report that their external pharmacy benefit managers (PBMs) restrict their ability to deploy internal pharmacy resources to manage employee pharmacy benefits. In other cases, asking to carve out some areas of the employee pharmacy benefit from the PBM contract triggers increased fees.

The organization

Northwell Health is a fully integrated health system with 23 hospitals and more than 850 ambulatory sites, based in New Hyde Park, New York. Northwell’s outpatient pharmacy network, Vivo Health Pharmacy, has 10 brick-and-mortar locations, including three accredited specialty pharmacies, six hospital-based retail pharmacies, and one mail-order facility.

The approach

Northwell’s vice president and chief pharmacy officer, Onisis Stefas, partnered with the human resources (HR) team to identify ways to better control pharmacy benefit management for health system employees and dependents. Together, they expanded Vivo Health Pharmacy’s role from dispensing employee prescriptions to managing the full pharmacy benefit.

The results

Northwell Health leaders successfully launched Vivo Health PBM in 2018. Thehealth system realized 16% savings in their first year, in addition to improving thepatient experience for Northwell’s 68K+ health plan beneficiaries.