Updated: Mar 4, 2021
Can your broker, benefits department or PBM tell you how your pharmacy dollars are being spent? Are they able to identify savings opportunities? Unless you can confidently answer both questions with detailed metrics and actionable solutions, you need data analytics.
When applied to pharmacy claims, data analytics gathers and categorizes your data to breakdown spend and savings opportunities. Detailed analysis should provide a summary and drill-down view of participants, pharmacies, physicians, claims, and drugs so you can get true visibility to optimize pharmacy benefit management. For over a decade, the PCM team of industry experts has been analyzing pharmacy claims data to develop innovative, long-term solutions to the complex problems of tracking where your money is going and how to save more of it. With pharmacy analytics, your big data is turned into small data so you can make better decisions and harness your pharmacy spend. Going out to bid is an arduous process. PBMs come back showcasing the savings they could provide; however, not every generic contact or pricing structure is suitable for the unique characteristics of your pharmacy plan. Pharmacy analytics gives you an unbiased, third-party view of how a specific PBM contract or pricing structure influences your total spend, copays, and claims. Have questions about how specific drugs will be covered? At PCM, we compare your data against current and prospective PBM contracts so you can see exactly how much your plan and participants will pay for each drug. Once you have chosen a PBM, the hard work is over. However, assurances that contracted performance guarantees are being met need to be in place. Pharmacy analytics helps you identify errors by comparing your pharmacy claims against your PBM contract. Actual verses contracted rebates, dispensing fees, AWP discounts are clearly delineated so there is no question if you are getting agreed upon pricing. By not monitoring contracted rates verses actual rates, plan sponsors could be overpaying by tens of thousands of dollars each year. True visibility into your pharmacy data, with breakdowns and roll-ups, helps you optimize your pharmacy benefit management. PCM Analytics focuses on taking action. Built-in spend insights allow you to act on:
NDC exclusions and pricing
Fill claim review
DAW code review
Deep-dive claim identification at the participant, pharmacy, drug, and physician level allows plan sponsors to encourage participants to make more savings-oriented prescription decisions. For example, Participant A may fill their prescription at the local pharmacy down the street which charges a $10 dispensing fee per prescription. An analysis of your claims may show that the chain pharmacy a few miles away charges a $4 dispensing fee on the same prescription. With this information, you can encourage participants to switch pharmacies saving the plan money.
Savings at the drug level can also be identified by monitoring NDC exclusions and pricing. Drugs are assigned different NDC numbers based on manufacturer, distributor, dosage, and package size, each with a different sales price. PBMs, health plans, and insurers can choose which NDC number they will cover. Excluding certain NDCs gives them more control over drug costs. When a particularly expensive NDC slips through and is covered at the pharmacy counter, the plan and participant pay more. For example, Drug 1 may have two NDC numbers. The first lists the drug price at $1 per pill and the second at $3 per pill. Without monitoring NDC prices, a plan sponsor may be shelling out three times more than necessary for a covered drug. When you know which NDCs are covered and if there are less expensive alternatives, you can cut drug spend. Once you see where your pharmacy dollars are being spent, you can confidently find ways to save more money. Pharmacy analytics gives you data to make better spend decision. PCM’s analytics tool provide highly specialized, one-of-kind pharmacy savings solutions driven by our interactive, web-based platform. Start harnessing your pharmacy data to optimize pharmacy benefit management.