Plan Assessment

Plan Assessment to evaluate & improve your pharmacy plan performance

Plan Overview
Plan Management
Pharmacy Plan Overview & Performance Report

Does your plan measure up?

A Performance Report and Plan Overview is our typical first step in assessing the possible shortcomings of your current Rx plan. This is our spring board to a deep understanding of your true needs and what sets us on the right path to crafting you the perfect benefits plan.

We evaluate your current and potential plan performance, and compare that to your financial and clinical objectives, looking for initially obvious mismatches. If your plan lacks a long-term strategy or direction, we'll work with you to formulate a strategic blueprint for the future of your plan. Our process includes:

  • Evaluating your Pharmacy Benefit Manager (PBM)/Carrier Pharmacy contract and comparing it to the marketplace
  • ‍Assessing your plan design and how it impacts member behavior
  • ‍Gauging utilization of high-cost drugs, specialty and compounds
  • Evaluating key metrics such as plan cost Per Member Per Month (PMPM), generic fill percentage and mail utilization percentage
  • Comparing key metrics to benchmarks that match the incurred date of data or reports received
  • Evaluating and/or creating a strategy for meeting your plan’s financial and clinical objectives

To provide clarity-driven insight, we’ll integrate and normalize your data to get it report-ready. In doing so, we’ll review the available information detailing pharmacy transactions from your Rx plan and supplement that information with any additional clinical, demographic, administrative or financial information necessary for comprehensive reporting. In addition, we'll review custom ad hoc reporting requirements and use our experience to put together an implementation plan for any custom features you may need added to your dashboard. Once all of your data has been input, we’ll outline a process to update any shared references that could potentially change down the line, such as contracted discounts and rebates or groups added to the platform. Once report-ready, you’ll have the power at your fingertips to make your data work for you.

Equipped with a variety of reports, the following serve as examples of the types of reports we can provide:

  • Executive Summary
  • Cost Trends
  • Demographics – Claimants
  • Demographics – Plan Cost
  • Top 10 Drugs
  • Top 10 Therapy Groups
  • Top 10 Pharmacies
  • High Cost Claimants
  • Specialty Drugs
  • Specialty Top 10
  • Ingredient Cost Breakout and Trends
  • Glossary

To learn more about our consulting services, click the button below to download a copy of our brochure.

ON-GOING Pharmacy Plan Management

Rx evolves, your plan should too

The world of pharmacy benefits is dynamic, so why would your plan be stagnant? With an impactful, proactive approach to plan management, we support your plan and help it evolve along with the industry through an experienced team and an industry-leading analytic platform.

We serve as your personal pharmacy benefit specialist, helping to evaluate, modify, design and execute solutions to meet your specific plan goals. Ongoing plan management includes:

  • Review and renegotiate any contract terms that might be minimizing discount performance
  • Developing a strategic plan and custom solutions to meet plan goals
  • Providing monthly, quarterly, and annual data analysis and reporting to identify trends, cost drivers, high-cost claimants and solutions to continue meeting goals
  • Presentation of reports at quarterly and annual meetings
  • Comparing your plan’s key metrics to benchmarks
  • Developing a plan to manage Specialty drugs
  • Developing monthly and annual plan design report that identifies claims not processed according to plan specifications‍

In addition to the above services, we continually enhance your plan performance by combining complimentary programs when indicated as beneficial by plan data we collect, aggregate and analyze. By doing so, we seek out solutions to target key areas of opportunity and help better manage plan expenditures. Programs we partner with include:

Generic over Brand Savings:

Our third-party partner helps us to counter the aggressive marketing of pharmacy manufacturers to physicians and end consumers through a no-risk savings program. We use your plan’s data to compile prescription alternatives that provide cost-savings for both the plan and the member.

Diabetes Management:

As the single most costly disease state, Diabetes also exacerbates more diseases than any other condition.  Our partner provides high-level insight through real-time monitoring of members treated with diabetes to improve compliance, save plan dollars by preventing catastrophic health events, and strengthen the network of support. In order to manage diabetes at the level of detail it requires, we collect biometric readings via Bluetooth, WiFi and cellular home-based devices and aggregate clinical and financial information into a comprehensive suite of population and risk management reports which include:

  • ‍Number of readings in the Danger Zone
  • ‍Monthly ER visits and associate costs
  • ‍Program adherence rate
  • ‍Gaps in care analysis for chronic population

Specialty Drug Management:

Once a specialty drug is approved, our third-party solution manages members on that drug after they have been approved for treatment. To ensure therapy goals are being met, this program:

  • Manages physicians/clinicians to ensure they are actively engaged with patients
  • ‍Monitors lab results to confirm continued eligibility for the drug
  • ‍Ensures the drug achieves the desired results and if not, change is made accordingly
  • ‍Manages the adverse side effects which result in unnecessary admissions and ER visits
  • Manages drug adherence daily
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