When setting up a pharmacy benefits plan, data is vital to designing a plan that meets your organization’s goals. It can impact formulary choices, strategies for controlling specialty medication costs, and choices of clinical program.
Understanding Your Data
If you are designing a plan with a new pharmacy benefits management organization, claims data from your existing plan is important to plan design decisions. Make sure your PBM is able to explain that data and how it can impact your plan and your members.
“We take the time to help clients understand our data analysis, our recommendations, and will discuss any custom initiatives they may want to pursue,” says Jacob Neyer, PharmD, Clinical Pharmacist with True Rx Health Strategists. “We believe it’s vital for clients to make an informed decision that balances cost savings with patient outcomes and any potential disruption to plan members.”
For example, data is often instrumental in helping clients make formulary decisions. “We look at a client’s current claims and determine what medications will be excluded if they went to a more restrictive formulary. We present numbers on how many members, drugs, and total claims would be impacted while also estimating rebates,” explains Clayton French, Data Analytics Manager, True Rx Health Strategists.
“For example, we might evaluate rebates increase by moving to the Exclusive Formulary from the Universal Formulary. The amount of disruption may be very large or very small depending on the medications the client is using. Is impacting 100 members and their medications worth $15k more in rebates? It is all up to the client to decide, but it’s our job to give them the correct data so they can make an informed decision.”
Data Reporting and Continuous Improvement
Once a pharmacy benefits plan is set up, your PBM should never have an “autopilot” attitude. Plan monitoring and reporting help brokers and employers enhance plan performance. True Rx uses four types of data analysis to help companies understand and potentially improve plan performance.
- Key Performance Metric Reporting: Your plan performance is measured on a monthly, quarterly, and annual basis, tracking cost and utilization trends to identify savings opportunities before they become cost challenges.
- Plan Modeling Impact Analysis: If you are considering a new clinical program and/or copayment adjustments, data can be used to identify plan cost savings and corresponding member disruption.
- Benchmarking and Book of Business Reporting: Get more context in your reports by comparing your plan performance to clients who are similarly situated in the market.
- Ad-hoc Reporting/Analysis: If you have specific needs, True Rx can create custom one-time or recurring reporting and analyses.
How Data Helped Two Organizations Lower Costs
A manufacturing firm with 4,000 plan members saved $79,000 over a six-month period.
The Data: Data from plan reviews revealed that specialty infusion medications were some of the highest drug costs for this employer.
The Solution: At the recommendation of True Rx, the company implemented True Codes, a program that helps control the costs of specialty infusion medication while also improving patient care. True Rx clinicians work with the patient and doctor to explore outpatient infusion center options that provide high quality care, convenience, and lower treatment costs. Savings are achieved by billing the medication to the prescription insurance plan rather than the medical plan.
A formulary change yielded more rebate dollars for a technology firm.
The Data: The employer had 122 fewer plan members than the year before and also needed to save more money.
The Solution: By running plan modeling impact analysis, True Rx determined the company could increase rebate dollars by changing the plan formulary from Universal to Exclusive. In the first 6 months of the new formulary, the 922-member plan saw rebates increase by $12,803.
Learn How Transparent Data Can Help You
To explore how our health strategists can utilize data to create customized solutions for your organization or clients, contact our Business Development Team at email@example.com