This year saw a post-pandemic return to preventive care, the introduction of several biosimilars, and legislation governing healthcare transparency. However, stakeholders are still working to contain medical and pharmacy costs while providing high-level benefits to plan participants. The Prescription Care Management (PCM) team of experts has worked to build analytics-driven insights and tools to help brokers, consultants, and plan sponsors start 2022 with actionable solutions to plan management, cost containment, and engagement.
Aggregated Plan Reporting
Pharmacy and medical plan management are fragmented. Balancing ancillary programs, administrative services, consultants, brokers, third-party payors, and more can leave spend and savings numbers fuzzy. Bringing savings from just a handful of third-party vendors back into per member per month savings can be time-consuming and tedious.
Aggregating plan reporting allows stakeholders to more easily see a high-level view of spend and savings and drill down to specific solution metrics. PCM’s interactive analytics platform provides the vehicle for aggregated plan reporting. Not only are our in-house programs and custom solutions displayed side-by-side for a great on-screen experience, but the platform also hosts a suite of reports that allow stakeholders to have consistent, uniform data displays and accurate whole-plan validation. Gone are the days of pulling several vendor reports to create a custom spreadsheet. With PCM, plan reporting is simple.
Market Check and Performance
Simplifying claims repricing and PBM contracting is imperative to validating contract performance. Employee cost share, administrative fees, discount percentages, rebate amounts, and utilization all impact the efficiency of your PBM contract.
Instead of going out to bid to explore contract options, PCM’s Market Check tool allows stakeholders to dynamically compare contracted and effective rates to market PBM rates to negotiate better contracts and design a client-centric program.
Likewise, our Performance tool encourages meaningful conversations as actual data is compared to contracted data to identify anomalies, errors, and guarantees. Contracts validation leads to rates that are in line with negotiated guarantees and serve plan goals.
As the industry becomes more transparent, rebates are still in a black box. Without drug-level reporting, traditional formularies are driven by drug rebates, not clinical effectiveness nor plan efficacy, limiting stakeholders’ opportunities to contain costs. By leveraging a pharmacy-based technology platform, PCM has developed a supplemental solution that gives plan sponsors the visibility to take ownership of critical plan components and achieve plan goals.
Drug-level rebate visibility allows plan sponsors to balance clinical efficiency with cost containment to achieve plan goals.
While the rising cost of specialty drugs in the pharmacy channel is still headline news, stakeholders need to consider specialty drugs covered by the medical benefit. Drugs in the medical pharmacy category are typically administered in an in-patient or clinic setting and require additional supplies or services that make them very expensive. Billed as J Codes, medical pharmacy drugs have high but opaque price tags leading to higher costs for stakeholders.
PCM’s J Code Crosswalk allows stakeholders to see the actual cost of drugs covered by their medical benefits by pairing J Codes with NDCs. This transparency provides opportunities for stakeholders to develop clinical management and patient care strategies that balance clinical care with cost.
Crafting a pharmacy and medical benefits strategy with cost and clinical transparency is complex. That is why Prescription Care Management (PCM) has done the work for you. In addition to an interactive analytics platform, PCM provides cost containment and engagement options to build a plan-focused benefit program. To see how PCM is helping stakeholders simplify plan management, click here.