Pharmacy and associated medical costs are unsustainable! Functional silos, antiquated platforms, and status quo leadership have plagued the PBM industry for decades, providing no actionable alternatives to plan sponsors. It is time for plan sponsors to replace legacy PBM services with an innovative, integrated, and transparent PBM partnership model.
Today, avoidable medical costs are exceeding over $700 billion. While half of these costs are attributed to physician and hospital abuse, misuse, overuse, and incompetency, the remaining half are classified as “avoidable drug-impacted medical costs”. The PBM industry, which manages over $370B in prescription drug-spending, provides limited and fragmented services, forcing plan sponsors to outsource critical functions to multiple vendors. This shortsighted practice has led to a lack of “single-point-accountability”, introducing an additional $350B of avoidable drug-impacted medical costs into the healthcare delivery system. Legacy PBMs are unable to take avoidable drug-impacted medical risk due to their inability to comprehend cost and quality management, and therefore end up providing only low-value transactional services. In the care continuum, only vendors who excel at managing cost and quality will be willing to take risk to guarantee the reduction of these costs.
In addition, in order for plan sponsors to appropriately manage $120 billion specialty drug spend, the poorly managed “Buy & Bill” model must be converted to an “Authorize & Manage” model. At RxAdvance, we employ a holistic approach to manage this $840B total spend, bringing to an end the days of limited, fragmented, and inflexible PBM service delivery.
To accomplish optimal utilization of drug benefit, reduction in overall pharmacy costs, reduction in avoidable drug-impacted medical costs, and optimization of specialty spend, RxAdvance knows that it is critical to engage members, physicians, pharmacists, and plan sponsor’s clinical/pharmacy staff in the decision-making process. At RxAdvance, such collaboration is delivered through the Collaborative PBM Cloud™ platform, resulting in a new paradigm of collaboration in the PBM industry. The Collaborative PBM Cloud™ platform revolutionizes the delivery of actionable intelligence to the physicians at the point of care, pharmacists at the point of sale, and members through mobile cloud, while effectively engaging the plan sponsor’s clinical/pharmacy staff through their respective case/care management workflows. The Collaborative PBM Cloud™ also allows RxAdvance to run with 40% less operating costs than any other PBM. These cost savings provide additional reduced administrative fees, reduced drug unit costs, and increased rebate income to plan sponsors.
RxAdvance, a national full service PBM, leverages the disruptive Collaborative PBM Cloud™ to manage standard and specialty drug benefits with unmatched regulatory compliance and transparency. In addition, RxAdvance is willing to share global pharmacy risk, avoidable drug-impacted medical risk, and bundled episode specialty pharmacy risk, standing shoulder-to-shoulder with plan sponsors as a true accountable partner. This risk model has never been offered by any other PBM.
Our tailored, world class services are for all plan sponsors — health plans, accountable care organizations (ACOs), exchanges, state Medicaid programs, and employer groups.