Current State of the PBM Industry
PBMs have traditionally managed about $370 billion in prescription drug spend for plan sponsors. They tend to provide limited transactional services through their use of antiquated systems, leading plan sponsors to outsource critical services to multiple vendors. This has created no single point of accountability in the health care continuum, leading to an additional $350 billion of avoidable drug-impacted medical costs. Additionally, specialty pharmacy costs have grown to over $120 billion, and will continue to grow to $150B by 2019. Despite these spiraling costs and the unique position of PBMs to harness their role in the transaction cycle to influence change, these entities seldom elect to take risk to manage these costs, as they are uncertain in their ability to manage cost and quality.
Redefining Pharmacy Benefit Management
RxAdvance spent the first two years of operation constructing a PBM enterprise platform from the ground-up to eliminate the costly silos in the healthcare continuum. By employing innovative strategies, such as cloud-computing and deep data analysis, RxAdvance built the Collaborative PBM Cloud™ on a unified data model, enabling a more collaborative, integrated, and comprehensive approach to pharmacy benefit management. This world-class, intelligent platform operates with 40% lower operating costs than other PBMs and effectively reduces costs for health plan sponsors. These cost savings provide additional reduced administrative fees, reduced drug unit costs, and increased rebate income. With system-driven compliance rules built in, RxAdvance is able to manage standard and specialty drug benefits with unmatched regulatory compliance and transparency. Additionally, RxAdvance’s pharmacy benefit services follow an approach that is data-driven vs. perception-creation, enabling 10-12% reduction of overall pharmacy costs, 10-15% reduction of specialty costs, and 20-25% reduction of avoidable drug-impacted medical costs.
RxAdvance acts as a true partner to plan sponsors, even beginning with the PBM selection process. Collaboration is key to successful and effective pharmacy benefit management. To accomplish optimal utilization of the drug benefit, reduction in overall pharmacy costs, reduction in avoidable drug-impacted medical costs, and optimization of specialty spend, RxAdvance sees that it is critical to engage all stakeholders 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 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 care management workflows. 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 truly accountable partner. This risk model has never been offered by any other PBM. RxAdvance has proven itself as the most qualified and responsible PBM, acting as a trailblazer in the industry by becoming the first PBM to provide such an integrated model.
Over the decades, due to lack of an integrated, scalable, and advanced technology platforms, traditional PBMs have introduced a notion into the market place that converting to a new PBM causes member service disruption, is expensive, and is time consuming in order to maintain their incumbency. By leveraging an integrated technology platform built on a unified data model, RxAdvance aims to erase this notion from the marketplace. Due to RxAdvance’s operational efficiencies and the platform’s ability to process workstreams in parallel, RxAdvance is able to implement clients in less time than traditional PBMs, while also ensuring that members do not experience disruption of service. RxAdvance has implemented a large health plan client, which would typically take a traditional PBM 4-6 months, in as few as 8-10 weeks. The unified data model makes implementation and maintenance simple. All applications are integrated so that changes in one module are immediately reflected in the other in real-time, eliminating opportunities for human error from manual updates as well as the opportunities for processing errors from delayed updates.
RxAdvance’s agility is also reflected in its Account Management style. Account Managers represent the voice of the customer within the organization and are involved in most aspects of operations, planning, and delivery work streams within RxAdvance. The Account Management group is a key part of RxAdvance’s corporate initiatives and client servicing team, which is accountable and empowered to deliver exceptional value to our customers on a daily basis. Account Managers are thoroughly trained on the technology platform, so that they have deeper insights and a heightened awareness of client specific needs. This unique approach ensures that RxAdvance is listening to its business partner’s needs and concerns everyday and that Account Management associates are able to intelligently and quickly respond to questions, rather than act as mere communication facilitators.
At RxAdvance, we consider transparency a guiding principle, meaning that the company was founded, and the platform built, upon providing completely transparent services to all customers. The word “transparency” is frequently referenced in the pharmacy benefit management marketplace, however, it is evident that this term is defined very differently depending on the entity. At RxAdvance, transparency simply means that the client sees what we see– in every facet of our operations. RxAdvance’s commitment to delivering comprehensive transparency includes visibility in operations, finances, utilization, cost & quality, compliance, and modeling.
Not only does RxAdvance pledge to provide full visibility into the above activities, RxAdvance also provides this complete transparency to clients’ fingertips at all times through role-based access to our market-leading Collaborative PBM Cloud™ platform. For example, within the realm of financial visibility, the Collaborative PBM Cloud™ provides extensive visibility into network performance and rebate guarantees. RxAdvance offers both traditional and pass-through pricing to potential clients, but in either case RxAdvance will provide complete financial transparency. Regardless of the pricing structure, for example, clients will have the 24/7 ability to see how much we are billing to the plan sponsor, how much we are paying to the pharmacies, how much we are invoicing the manufacturers directly and indirectly, and how we are meeting the defined performance and financial guarantees. Similar transparency and reporting capabilities exist for network guarantees, operational and performance guarantees, compliance measures, and utilization.
Passion is what drives the RxAdvance team. Since its inception, RxAdvance was built with a noble cause in mind. Our vision is the enable the coverage of both the underinsured and uninsured, while also lowering premiums for all Americans. We believe this is possible by partially reducing the $900 billion of healthcare waste. With this in mind, we focus on constantly working towards excellence, relentlessly pursuing innovation and optimization. RxAdvance focuses on continuous improvement and rejects complacency, always on top of incorporating innovation and improving efficiency to adapt to the ever-evolving landscape of healthcare.