Updated: Mar 4
Our dynamic healthcare system is full of “big data” from the information, statistics, and trends of participants, physicians, plans, and third-party administrators. This is especially true for the pharmacy management industry. Large amounts of data – including participant, prescription transaction, supply chain, insurance, PBM contract, and marketplace data - are exchanged between PBMs, pharmacies, and insurers.
While this data directly influences the management of participant adherence, formulary construction, and overall pharmacy spend, the key stakeholders in the pharmacy plan, brokers and plan sponsors, rarely have true visibility into their pharmacy plan.
Data analytics is changing all of that.
Garret D’Antoni, CFO at Prescription Care Management (PCM), explains, “Data analytics is bringing insight to a complex industry. From summary data to drill-down details, analytics helps us understand where and how money is being spent.”
Many brokers and plan sponsors have been working from top-level summary data. From this view, there may be a suspected problem, but the details required to figure out a solution are hidden in rows and columns of data.
“Summary data, like total claims or total spend, can help identify the problem,” continues D’Antoni, “but data analytics gives you the details to identify the solution, and the key to really digging into your data to find those solutions is powerful data analytics.”
Finding a Powerful Tool
As data analytics becomes more prevalent in pharmacy management, it is vital to understand what type of tool you really need to get an accurate look into your pharmacy data.
Here are three key features to consider when shopping for a powerful analytics tool.
Key 1: Ease of use
While aesthetics and design may seem minor in comparison to results, when you begin sorting through thousands of data points, ease of use will be vital to successfully mine data to implement positive change.
A powerful data analysis platform should offer:
Clean organization and clear screens
Customized views through filters and date ranges
Detailed reports and in-depth drill-downs
Simplified RFP data
Data should be centrally located, easy to navigate, and clear. An effective analytics tool provides an understanding of your pharmacy data in minutes, not hours, and should simplify your processes.
Key 2: Unbiased metrics
Your PBM is a valuable link in the prescription drug chain that adjudicates and processes claims on behalf of your plan, but PBM contracts and reports are complicated. Upon request, your PBM should provide reports that explain contracted guarantees, rebates, and fees. However, these reports may not be provided at all, may be incomplete, or may be biased toward showing savings by your PBM rather than giving an accurate picture of how your PBM contract is impacting costs.
With a powerful analytics tool, all of the data is available, so you get an unbiased, third-party look into your PBM contract. Any analysis should result in two major unbiased metrics:
A performance guarantee comparison that gives you a clear look at actual costs versus contract guaranteed costs.
A plan repricing comparison between multiple PBMs and pricing structures.
Holding your PBM accountable for contracted guarantees is important to managing a healthy, financially sound pharmacy plan. A powerful analytics tool provides unbiased data on how your PBM is actually influencing the cost of your plan.
Key 3: Actionable solutions
The most important feature of an analytics tool is actionable solutions. Most platforms will provide summary analytics about your basic claims data and PBM performance guarantees, but the best tools go beyond data organization to outline concrete, actionable steps. These tools provide functional insight into:
NDC exclusions and pricing
As a broker or plan sponsor, you don’t need more data, just better direction. A powerful analytics tool puts your data to work by providing real, actionable solutions.
“Data analytics helps you find where the problems are and then segments and unpacks the problem to create true understanding,” says D’Antoni, “With this understanding, brokers, consultants, and plan sponsors can fix the problem.
If a pricing issue or disease issue pops up, the data will tell you the problem and then you can develop a solution or find one in the industry.”
It is time to start conversations, discover functional recommendations, and better manage your pharmacy benefits with a powerful analytics tool that is easy to use while providing objective metrics and real savings solutions.