Formulary and rebate management are the most complex and least-understood aspects of the pharmacy world. For that reason and others, pharmacy benefit managers (PBM), health planners, and large employer groups are intensely looking for ways to understand better and manage formulary and rebates. By obtaining clarity and critical insights into health plans and drug benefit programs, they intend to develop new strategies to control costs and to maintain an affordable, quality drug plan for their members. Although there are many pharmacy management solution providers in the market with varying competencies, most of them lack expertise in formulary and rebate management space and often deliver a ‘one-size-fits-all’ approach, which isn’t adequate to meet clients’ unique needs and go-to-market strategies.
Having recognized the complexity of formulary and rebate management space, Gateway Health Partners set out to simplify the lives of PBMs, health plans, and employer groups through its innovative technologies, expertise, and services. “Our client first approach, deep-rooted knowledge of formulary and rebate management combined with best-in-class services and lowest net cost is what makes us the trusted partner in the market,” mentions Ashley Beatty, President of Gateway Health Partners.
Unlike other competitors, the company’s mission is to drift away from one size fits all approach and deliver a personalized solution for the market. “By bringing clarity, insights and expertise, we create solutions that are flexible and customizable to the client’s specific needs and go-to market strategies,” states Ashley.
Today, Gateway is recognized as an industry expert, not only because of their team’s extensive background but the way they work behind the scenes to simplify the process. Ashley adds, “Our team of experts constantly monitors business trends; we listen, negotiate, and research ways to create customized tech-forward solutions. All-in-all, we look at ourselves as an extension to our clients with a proactive lens and an expertise that they can lean on.”
A Unique Value Proposition
Apart from rebate and formulary management services, Gateway also specializes in offering contract managementtools and cost management solutions. “Our solutions span everything from pricing strategies, underwriting, marketplace trends, competitive intelligence to developing unique go-to market strategies and business plans,” says Ashley. The company has recently launched new services, drug benefit programs, and tools. NetOptimizerRx is one of the newly introduced services, which operates as the next generation of network management services.
Anchoring the pharmacy network expertise that Gateway has acquired with its industry-wide relationships, it acts as one of the most efficient, agile, and customizable analytics tools for downstream PBM and health plan clients to best manage their retail network, contracts and also improve their profitability. “While implementing our solutions, we work with our clients 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’s dynamic contract management analytical tool—ProOptimizer—allows users to automate their submission and drive compliance in regard to the contractswith pharmaceutical manufacturers. Accurately and efficiently administering pharmaceutical manufacturer arrangements, ProOptimizer adds clarity and provides insights into their contract management, using Gateway’s deep expertise, industry-wide relationships, large-scale volume positions, and more. The flexible tool allows clients to derive value from the contracts by adhering to contractual parameters with their pharma agreement and providing seamless integration with their other analytics tools. Along with rebate submission, the user can also manage the payments and reporting while monitoring the reconciliation functionality and downstream client impact within a single, sophisticated system.
As the pandemic set off on a splurge of unprecedented devastation worldwide, the pharmacy industry also suffered a considerable blow. PBMs failed to execute rebate deals to provide the right incentives to the right trading partners in the light of dramatic changes in demand and revenue. Resultantly, Gateway responded to the crisis by rolling out a new prescription discount card program for clients at the member level. “Gateway, obviously identified the issues that could come along with this unprecedented pandemic and worked to roll out a drug discount card that provided access to discounts on brand name, drugs, and generic. Members can now receive up to 85 percent of savings by presenting a coupon or ID card,” explains Ashley.
Gateway Health Partners work with PBMs, Health Plans, and Employer Groups all over the country. The concierge service helps clients in every situation while navigating them through the complex pharmacy environment where one-size-fits-all does not prevail. As a part of the client engagement process, the company’s team invests a significant amount of time analyzing the customer’s environment, understanding their pain points and objectives, and subsequently craft solutions that are scalable and sustainable.
The impeccable line of benefits with Gateway’s services has turned them into the largest independent provider of rebates and formulary management services, acquiring a surfeit of clients and their success stories onthe way. Ashley reminisces an instance wherein, through their sophisticated contract management tool within NetOptimizerRx, one of their clients could eliminate millions of dollars of potential client contract liability while also optimizing overall retail network profitability and capabilities. “It was not only an overall uplift to their downstream clients, but internally the financial benefit of the sophistication of the state-of-the-art analytics by Gateway created risk mitigation as well as profit margin opportunities,” exalts Ashley.
The company also rolled out a new consulting service segment to educate clients on how to deal with the pharmacy industry’s complexity. “Our goal is to give them what they need to make important decisions around the overall prescription drug costs and their role in managing those costs for downstream clients,” avers Ashley.
“Gateway’s pipeline is stronger than it’s everbeen. And even though we are spotlighting our formulary and rebate management, the value that we can provide through our consultation services is something that we’re really excited about,” affirms Ashley as she ruminates on the company’s progress this year. The company plans to add more capabilities to its products and services to grow and compete in unique market spaces for the road ahead. Be it helping PBMs, offering market intelligence, or benchmarking, Gateway Health Partners is ready to kit themselves out using the vital partnerships and credibility that the company has achieved in the market to solve all impediments centering rebate and formulary management while staying true to their three tenets--clarity, insights, expertise.