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Incredibly Fast Turnaround

Client

Commercial Plan

Challenge

A contractual issue with the previous vendor required PharmPix to implement their pharmacy benefits over a weekend. Accurate and complete eligibility data was lacking.

How We Fixed It

PharmPix worked with the eligibility data that was available and built a customized eligibility tool, made an eligibility call center available with access to the eligibility tool to correct inaccurate eligibility data, and came up with a communication strategy with providers to make them aware of the sudden change of PBM. We effectively used our Power Copy tool and enhanced their platform capabilities.

End Result

Our client was very happy with their new accurate benefit design and formulary management. PharmPix successfully transitioned all of its members in just one and a half weeks.

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Medicare Cost Savings

Client

Medicare EGWP MA Plan

Challenge

The plan was suffering elevated pharmacy costs of $149.85 PMPM (Per Member Per Month) in 2010. It needed a costs turnaround in order to survive in a Medicare-regulated environment.

How We Fixed It

PROSSAM Plus transitioned into PharmPix’s full PBM services effective January 1, 2011. PharmPix then managed the client's pharmacy benefits for the following 10 months, decreasing their pharmacy costs to $119.12 PMPM. This represented a reduction of $30.73 PMPM or 20.6% from 2010. From this reduction, $7.68 PMPM, or 25%, was due to pricing reductions.

End Result

Utilization reduction represented 75% savings within less than a year, or $23.05 PMPM. Our client survived and thrived in their Medicare-regulated environment.

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High Level of Customization

Client

Workers Comp

Challenge

This client, the local universal worker’s compensation organization in Puerto Rico, identified the need for a front-end pharmacy system for its 20 internal pharmacies that would provide adequate dispensation and inventory records and controls, and a PBM component to deploy clinical, quality, and utilization management tools. The project’s specifications called for a very high level of customization, way beyond the normal pharmacy benefits administration.

How We Built It

Eligibility

Integration

Customization

End Result

Through PharmPix’s PBM services, the client is now able to coordinate pharmacy benefits with the Puerto Rico employers it serves. This successful implementation was completed in just 7 months.

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The Details are in the Data

Client

Assurance Health Administrators

Challenge

Overuse of brand medications

How We Help

Visual analysis to help plan sponsor understand cost impact

Often PBM proposals are evaluated based on their ability to contract brand discounts and manufacturer rebates. Most experienced pharmacy benefit managers realize that generic drugs offer a significant opportunity for savings and rebate strategies, which can conflict with lowest net cost. The fact of the matter is both strategies have merit. Depending on agreement or actuarial data used for full AWPs, both brand and generic and generic substitution rates, the following analysis depicts two times the savings for a 1% increase in generic utilization compared to a 1% discount in branded drugs.

Understanding the math
Understanding the math

Total Cost Savings from 1% increase in GDR is twice that of just under 1% increase in brand discount.

End Result

Increased GDR (generic drug utilization) by 10%

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