Background and Corporate Goals

Pharmacy Outcomes Specialists’ goal for the last 13 years has been clear and unwavering:  to provide plan sponsors with expert pharmacy benefits consulting to help lower costs and increase the health and productivity of the membership.

Pharmacy Outcomes Specialists started in 1996 when pharmacy costs were $200 per member per year.  There were no consulting firms at that time specializing in just pharmacy benefits consulting. But Pharmacy Outcomes Specialists’ founders realized that with the United States workforce growing older and technology advancing, prescription drugs were going to be more important than medical costs in terms of employee productivity, member satisfaction and bottom line profits. By 2006, drug cost per member per year average over $700, with retiree costs as much as $2,000 per year.

At the same time drug costs have increased, publicly traded pharmacy benefit managers – the middlemen between pharmaceutical companies and plans sponsors– have had exorbitant profit increases.  These increases have come, in part, by creating margins between amounts that pharmacies are reimbursed and amounts plan sponsors pay for the same prescription orders and carving up rebates into dollars retained by PBMs and dollars that PBMs determine they will pass back, in portion, to the plan sponsor. 

Lastly, a convergence of complex pricing rules, advanced computer technology, expensive life saving specialty drugs and a blend of brand/generic/over the counter/behind the counter product array leave manager confused and frustrated as to the best way to manage costs and make members happy.

Pharmacy Outcomes Specialists is uniquely positioned to assist plan sponsors and pharmacy providers sort out the mess.  Whether you are a middle sized employer trying to find a better PBM relationship or a large complicated health maintenance organization trying to sort through Medicare Part D rules or a regional chain trying to make sure PBMs are living up to their reimbursement terms, Pharmacy Outcomes Specialists can help.

Conflicts of Interest

An important note:  Consulting firms, like Pharmacy Outcomes Specialists, are NOT subject to the Sarbanes-Oxley Act which is an amendment to the laws governing the Securities and Exchange Commission. It applies exclusively to financial audits of public held companies and the governance of public accounting firms that conduct those audits and the corporate boards that engage the audits.  In other words, Sarbanes-Oxley applies to accounting firms auditing financial statements and prohibits those auditing firms from providing additional services to the same firms that they are independently auditing on behalf of the Board of Directors.  Pharmacy Outcomes Specialist is not a Certified Public Accounting firm specializing in the preparation of financial statements; hence Sarbanes-Oxlay Act does not apply to our firm. Consulting firms that are "third party auditors" - auditing the services provided to companies - are not subject to Sarbanes-Oxley because we are not independent of our clients but are indeed working for our clients.   This is not a conflict of interest and allows us to both audit PBMs and provide services to clients like helping find a PBM. Many PBMs would like to prohibit auditors from also providing RFP services but this prohibition is not appropriate.

Pharmacy Outcomes Specialists does not have a conflict of interest in how we provide consulting services.  We are paid by our clients on a flat fee basis.  Every project has a quoted price that Pharmacy Outcomes Specialists does not exceed unless the scope of the project changes.  We do not retain commission or any monies from PBMs, unlike other consultants.  We are only beholden to our clients to get the job done timely and accurately.  Ask your consulting firm to complete this form stating that they do not take money from PBMs.