Given the complex world of formulary and rebate management, pharmacy benefit managers (PBMs), health plans, and employer groups have a hard time developing strategies that control costs and maintain an affordable and high-quality drug plan for their members. Essentially, they need to have a close look at the pharmacy networks, generic and brand name drugs to alter their plans according to the changes in the market. However, for long, PBMs, health plans, and employer groups have been shackled with ‘one size fits all’ solutions that hamper the flexibility needed to quickly adjust to market dynamics and devise suitable plans for their members. All the while, these rigid solutions fail to create customized formulary programs and rebate management as required.

”We take pride in our ability and agility to be flexible and create custom solutions for our clients”

Changing the narrative here is Gateway Health Partners. Quite easily the largest independent provider of rebate and formulary management solutions, Gateway Health Partners makes the world of formulary and rebate management a lot less confusing for stakeholders. With rebate management at its core, Gateway Health Partners is also referred to as a ‘pharmacy cost containment management company’ as it helps realize cost savings for generic and brand drugs.“We are established in the market as an independent provider of rebate and formulary management service with the most unique ecosystem that drives flexibility and cost savings for our clients,” extols Ashley Beatty, President, Gateway Health Partners.

Flexibility and Customization to the Core

“We take pride in our ability and agility to be flexible and create custom solutions for our clients,” says Ashley. The company understands that the main pain point for any PBM or health plan is to manage contracts on the costs of goods side. Gateway Health Partners has developed various manage the payments and reporting while monitoring the reconciliation functionality and downstream client impact within a single system. ProOptimizer allows clients to avoid risks from a contract compliance perspective and ensures that they get the best value out of the contracts they have with their pharmaceutical manufacturers.

To serve other aspects of PBM organizations, such as the retail pharmacies, the company has recently launched a concierge of services to help clients. The NetOptimizerRx is the next generation of network management services that optimizes the client’s current network and robust data analytics focusing on contract management. Gateway Health Partners has also created another module of the contract management tool under NetOptimizerRx, which pivots over to the pharmacy retail side. This tool helps with pricing performance and compliance requirements when PBMs and health plans contract with pharmacies, grocers with pharmacy networks, and large chains using highly sophisticated analytics.

The solution allows the dynamics and nuances tied to pharmacy contracts to be captured and managed appropriately.

Gateway Health Partners has devised a similar tool catering to the client’s needs that securely manages and tracks client performance. It provides downstream clients with the ability to make adjustments and gain insights on the contract and performance throughout the year. To enable downstream PBM and health plan clients to manage their retail network contracts best, and optimize profits, Gateway Health Partners leverages its industry-wide knowledge and offers efficient, agile, and customizable analytics tools. “We work with our clients during implementation to determine which component of this tool is best suited for them, and accordingly deploy the required analytics tools for our customers,” adds Ashley.

Gateway Health Partners assists PBMs by offering market intelligence or benchmarking using its vital partnerships and credibility that it has achieved in the market. The company solves all impediments centering rebate and formulary management while staying true to its three tenets–clarity, insights, expertise. In one of the instances, Gateway Health partners enabled a client to create timely compliance with their submissions to pharma with the ability to do robust reporting internally to manage rebate and formulary processes. All in all, the client was able to drive compliance in regard to the contracts with the pharma manufacturers that they managed directly.

Illustrating another example, Ashley points out a PBM struggling to capture all the moving parts in terms of client-side contract management. Initial interactions with the client showed Gateway Health Partners a list of risks due to inappropriate records of client contracts. The client installed the NetOptimizerRx contract management tool that enabled them to leverage the sophistication of robust reporting on a bi-weekly basis to track, manage, and mitigate risks for any contracts with pharmacies or clients in a proactive manner. “Our tool can be deployed by any health plan or PBM that has downstream client contracts because it provides robust reporting on a regular basis giving them time and flexibility to make adjustments as required,” explains Ashley.

Being the growth engine of its clients’ success, Gateway Health Partners’ level of expertise and sound knowledge across all facets of the pharmacy management ecosystem is steering them ahead of the competition. By harnessing advanced technology with its suite of expert concierge services, the company has added new dimensions to rebate and formulary management.

Recognized as an industry expert, Gateway Health Partners draws from its team’s extensive background in rebate and formulary management. The team of experts constantly monitors business trends while researching ways to create customized tech-forward solutions. In essence, the company acts as an extension to its clients with a proactive lens and expertise that they can lean on. Gateway Health Partners deeply understands the clients’ needs within the specific markets they serve. Accordingly, the team helps them drive clinical programs and evaluate the ones that can improve their members’ health and outcome while also bringing in overall savings.

Above and Beyond Rebate Management

Even during the unprecedented times of the ongoing pandemic, Gateway Health Partners has remained steadfast and tried to understand client’s challenges related to pharmacy management. Continuing to work closely with clients, Gateway Health Partners is focusing on cost containment and is keeping an eye on industry regulations to keep up with new changes and trends. Similarly, the company is also supporting and providing unique and customized underwriting and pricing solutions to clients. “We want to be as agile as possible to continue to be a high growth engine for clients behind the scenes as they look to cater to their target market,” says Ashley.

Gateway Health Partners is committed to reaching out to more clients and meeting their needs with its comprehensive services. The company plans to add more capabilities to its products and services to grow and compete in unique market spaces for the road ahead. “As the market continues to evolve, we are very mindful of leveraging new opportunities to progress as a pure pharmacy management cost containment solutions provider for our clients and prospects,” Ashley signs off.