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John Ottavi, CPCU, GBA

Vice President

Cottingham & Butler



The program will broadly hit on pharmacy cost containment with a focus on Specialty.    Employers have not implemented many fundamental cost containment strategies including:


  1. Step Therapy
  2. Mandatory Generic
  3. Mandatory Maintenance Mail Order
  4. Prior Authorization
  5. Excluding Compounds – Prior Authorization on Compound medications
  6. Excluding manufacturers coupons – this is tough one for the PBM’s
  7. Medical necessity on Specialty RX –
  8. There are six defensive walls employers should build around Specialty to protect plans.  Any specialty prescription that wants to be paid from plan resources should pass through six checkpoints:#1:  Should the drug even be covered?#2:  Is the drug appropriate for the member?

    #3:  Has the member been incentivized to use available alternatives?

    #4:  Has the supply of the drug been minimized?

    #5:  Has the cost of the drug been minimized?

    #6:  Have you ensured the member is actually paying their cost sharing?


May 27, 2015
11:30 am - 1:00 pm


Employers Healthcare Coalition Office
636 Hampshire, Suite 206
Quincy, IL 62301 United States
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