Monday, November 2, 2020

Finally, a groundbreaking way to evaluate the impact of PBM utilization management programs: Innovu’s Pharmacy Program Analysis (PPA)

With the cost of healthcare rising and the cost of pharmacy benefits rising even faster, advisors and employers need to find ways to cut spending and reduce waste without sacrificing benefits to their employees and their families. From heartburn medication to pain relief, prescription drugs make up 26% of the average employer healthcare spend.

So, how can advisors and employers uncover waste and improve Rx spending without affecting employees and their benefits? Traditionally, pharmacy analysis has focused only on the discount and the rebate.  Innovu’s groundbreaking Pharmacy ProgramAnalysis (PPA) uses a unique approach that assesses an employer’s actual pharmacy spend using two more comprehensive variables, cost and utilization. The Innovu PPA results in a new and unique view of an employer’s Rx spending that can identify significant savings opportunities that may have previously gone unnoticed.

Innovu’s approach identifies five categories of savings within an employer’s pharmacy spend:

·      Wasteful spending

·      Generic drug utilization

·      Specialty drug utilization

·      DrugReclassification

·      Discounts/ Rebates

Pharmacy Program Analysis (PPA): A Closer Look

When marketing a pharmacy program, many advisors solicit information from Pharmacy Benefit Managers (PBMs) to help them control utilization and costs. However, evaluating PBM financials may only compare the differences in discounts, rebates and administrative fees. Innovu developed the PPA to provide an alternative approach, evaluating the collective impact of an employer’s prescription data and then assessing the financial impact of drug utilization plus prescription cost.

The Pharmacy Program Analysis affords all employers, regardless of size, the opportunity to identify wasteful spending in their Rx claims as well as the impact of the over-utilization of specialty drugs and the under-utilization of generic medications. The PPA also highlights the importance of having drug indicators in the claims data to reconcile the employer’s contract pricing. Without these indicators, employers are helpless to validate their contracted rates without conducting a full claims audit. By reducing wasteful spending and having the indicators to monitor price, an employer and their employees will have lower healthcare costs and more money in their paychecks.

What hidden savings are in your pharmacy spend? Is there unnecessary waste where a generic alternative might offer significant savings with no impact on effectiveness? Are your employees being prescribed drugs that add no additional clinical value?  How do specialty drugs impact the amount employers are paying on claims?

In the current healthcare climate, no one can afford to overspend when employee health and benefits are on the line. When every dollar counts, Innovu can give advisors and employers the power to make smart procurement decisions and get more affordable benefit coverage through better management of pharmacy programs.

To learn more about PPA, please contact your MD or email sales@innovu.com.


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