Nathan Holman, vice president of information technology for RxBenefits, tells us how the company uses data analytics, artificial intelligence and machine learning to reduce the costs of pharmaceutical benefits in the US healthcare sector.
What does RxBenefits provide?
RxBenefits is the industry’s first and only Pharmacy Benefit Optimizer (PBO) in the benefits industry. Most employers overpay for pharmacy benefits while receiving poor clinical management and customer service. In fact, more than 60% of employers say their prescription drug spending is expensive and unsustainable.
Our priority is to help self-insured employers maximize the value they and their members receive from their pharmacy investment. Our pharmacy experts work on behalf of employers, regardless of their medical provider or PBM, to lower their purchasing costs, eliminate wasteful expenses, protect the health and safety of their employees, and increase employee satisfaction. Our model reduces pharmacy spending by more than 25% in the first year, on average, and insulates the plan against future trend drivers such as high-cost specialty drugs.
How does RxBenefits use the data?
Our PBO model leverages advanced business intelligence and data modeling capabilities, derived from our proprietary analytics platform, RxAnalyzer, to identify risk areas and trend drivers in a company’s claims data, such as chronic conditions. health and high use of pharmacies, and to forecast costs. trajectory and impact of the program. By applying clinical experience to this data, we can recommend hyper-specific strategies to help the employer address any potential issues.
We also started incorporating artificial intelligence / machine learning and predictive analytics into a new technology platform called ONE.RxB. This platform, along with our other capabilities, will allow us to analyze a broader range of employer trends, patient demographics, prescription patterns, and more, as well as model that data, point out important ideas, and share recommendations to employers in real time. meeting a growing industry need for better access to data information.
By enhancing our data analytics capabilities, we will provide employers with deeper insights into employee health trends and tools to make more informed decisions about their pharmacy benefits.
How important is data analytics in the pharmaceutical benefits industry?
Without data, an employer’s pharmacy benefit plan is a black box. The pharmacy benefits industry is currently very opaque, with many employers stuck with either misaligned pharmacy contract terms or a complete lack of pharmacy contract.
It is essential that employers have transparent contract terms as well as full visibility of their plan performance to improve the health of their employee population at the lowest cost. The data analytics application is critical to gain this visibility.
When data analysis is applied to pharmacy benefits, employers can better evaluate their pharmacy benefit options, gain insight into the performance and utilization of their plan, discover potential risks, and make better decisions about their benefit programs. They can also analyze the cost and employee impact of any decision before making it.
Can you give us an example of this?
Using insights derived from our proprietary data analytics platform, RxAnalyzer, we forecast cost savings and member impact of each recommended strategy for our clients. With this knowledge, they are empowered to make the best decisions for their plan and its members.
They can generate benefits that appeal to current and future employees, optimize their well-being, and lower overall prescription drug costs. In fact, most employers can reduce their pharmacy expenses by more than 25% on average in the first year and guard against future factors that cause increased spending, such as increased costs and the use of specialty medications.
What key trends are emerging in the pharmaceutical benefits industry?
There are several trends, some of the main ones to consider are:
Specialty carving. We continue to see more innovative specialty drug therapies hitting the market each year, and the use of these drugs is increasing. Just 1% of prescription claims now account for roughly 50% -60% of an employer’s plan costs, largely driven by high-cost specialty drugs. In order to address the impact on employers, we are seeing an increase in employers exploring special exclusion programs.
Unfortunately, this practice can negatively affect members, who can be left out in the cold with no way to secure their necessary medications and employers still have to pay the bill. However, there are alternatives to the exclusion of specialties that protect both employers and their members. As specialty drugs continue to increase in both cost and use, employers should reevaluate their pharmacy benefit strategy and utilize an independent pharmacy expert who will operate in the best interest of them and their members.
Increased hospital costs: Hospital admissions declined significantly last year and are expected to lose as much as $ 122 billion again this year. Meanwhile, his spending and drug use continues to rise. In fact, 70% of the members of a hospital plan take prescriptions each year, which is 25% higher than the typical business plan.
In addition to that, 1 in 6 members of the hospital plan takes a higher priced drug. Hospitals play a dual role as a healthcare provider and an employer, and their employees expect a huge benefit, so it’s important that they carefully design a drug plan that balances access and cost while ensuring a service experience higher. This includes promoting in-hospital pharmacy, ensuring proper prescription and utilization of medications, implementing processes to eliminate waste on high-cost brand and specialty medications, and gaining access to Manufacturer Co-Pay Assistance Programs (MCAPs). ) and discounts on the price of 340B medications, if eligible and available.
As these trends continue to emerge for years to come, partnering with an independent advocate who proactively reviews your benefits plan on a regular basis can ensure that employers consistently have the best rates, reimbursements, and contract terms.
Do you think “virtual pharmacies” will be a standard way for people to fill their prescriptions in the future?
Virtual pharmacies accelerated during COVID-19 as patients needed more convenient healthcare offerings. For example, last year Amazon announced a remote retail pharmacy solution that will accept insurance and be in PBM’s pharmacy networks, taking advantage of PillPack, an online pharmacy that fills prescriptions by mail.
Costco also recently announced a new online pharmacy, and many traditional “brick-and-mortar” pharmacies now offer this option as well. More options like this are likely to continue to be available.
However, virtual pharmacies are simply another option for employees and members to fill their prescriptions for generic and brand-name drugs. Often there are key differences between a virtual pharmacy and an in-person pharmacy, and the benefits of each option. Employers should help inform their members of the pros, cons, and differences of each type of offering before changing their pharmacy benefit plans.