RxAdvance’s approach to managing pharmacy benefits is “data-driven” vs. “perception creation” for the plan sponsors
If a plan sponsor is currently using a large PBM then, RxAdvance has found that there is an opportunity to reduce pharmacy costs by 8%-12% by making small changes such as promoting untapped generics and adjusting from high cost to low cost generics. Just as well, there is an opportunity to reduce 40% of PBM operating costs through the use of a sophisticated platform, such as the Collaborative PBM Cloud™. By using a sophisticated and holistic platform, RxAdvance is better qualified to manage risk than traditional antiquated PBMs.
Traditional PBMs have only recently begun to manage specialty pharmaceuticals after years of neglect. Due to their oversight, specialty pharmaceuticals have been driven to a poorly managed “buy & bill” model. By converting this to an “Value-Based & Outcome-Driven” model, plan sponsors could realize 10%-15% savings on overall specialty costs. A fully effective conversion utilizing RxAdvance’s streamlined 10-step program could further savings. RxAdvance’s holistic platform manages specialty pharmaceuticals from end-to-end, employing the following ten-steps: Specialty Formulary Management, Specialty Network Management, Physician Education, Utilization Management, Prior Authorization Management, Procurement Management, Adjudication Management, Case and Concurrent Management, Financial Reconciliation, Monitoring and Measuring. RxAdvance’s expertise in specialty management has led it to be the first PBM to offer a bundled specialty group risk model where it will share risk with plan sponsors on specialty bundled episode groups (ex. HIV/HCV/CF/MS, etc.)
Avoidable drug-impacted medical costs have exceeded overall pharmacy costs. Due to traditional PBMs non-comprehensive approach, there has not been a single point of accountability in the care continuum. This oversight has introduced another $350 billion of avoidable drug-impacted medical costs into the healthcare system. By acting as a true partner through its risk-sharing model, RxAdvance is the only PBM capable of mitigating avoidable drug-impacted medical costs and managing the most unmanaged portion of managed care through risk sharing.
Despite what traditional PBMs are telling plan sponsors, they are not effectively and efficiently managing pharmacy, specialty, and avoidable drug-impacted medical costs. In order to truly manage these, you need a disruptive PBM player and a true partner, like RxAdvance, who looks at all of the costs holistically.