3 Steps to Level-Up Your Annual PBM Plan Review

business man and woman sitting at a table in front of a laptop in discussion

Annual plan review season is fast approaching and PBMs, consultants, and payers are all actively preparing for these critical conversations. A comprehensive plan review takes time to create. From compiling key information to distilling data into an easy-to-understand narrative, you have substantial work in store if you want to get it right.

Maybe you’re new to the industry and need some guidance on how to prepare for plan reviews. Maybe you want to improve your team’s net promoter score (a recent poll showed that a lack of timely and transparent reporting is a growing barrier to client satisfaction). Or maybe you’re a consultant looking to prepare for your client’s upcoming plan review.

At the end of the day, we all share a common goal: to facilitate a meaningful conversation where the client feels seen, heard, and confident in their PBM’s ability to effectively manage their prescription benefit. Here are three steps to achieve that goal.

1. Craft a Narrative Backed by Data

It’s important to follow the established agenda and make sure you hit all the points your client expects to hear. At the same time, use the opportunity to craft a compelling story. Here are a few ideas to help:

Highlight Success

What programs were implemented the previous year? And how did those help control costs? Take credit for what you’re doing to help optimize the plan design, control costs, and improve the member experience. Highlight the positive results you’ve worked together to achieve.

Break Down Trend Numbers

Show your client what is driving their trend. Use this number to start telling your story. What is their year-over-year trend? What does the forecast look like for the upcoming year?

When you use an advanced automation tool, like Xevant’s TrendLogic, you can quickly produce a detailed report that pinpoints the primary sources of pharmacy benefit cost increases by category. This will allow you to tailor plan recommendations for the new year resulting in better performance in less time.

Offer Recommendations Based on Actionable Insights

You should always have at least one to two recommendations for your client. They don’t all need to be massive plan overhauls – even smaller changes can add up to significant savings over time. Let the data guide those recommendations.

For example, you note an increase in GLP-1 utilization among diabetic members. At the same time, your client is debating whether to extend coverage of GLP-1s for obesity. Higher utilization combined with drug price inflation – anywhere from 3 percent to 5 percent for GLP-1s – will quickly add up to higher drug spend and higher trend. Some straightforward recommendations could include:

  • Formulary change to prefer lower-cost GLP-1 product
  • Stringent utilization management criteria for only weight loss use/approval
  • Care management programs to support lifestyle changes

Please note, this is not meant to be all-encompassing. Only you know your client and the unique PBM programs available to them. But when you notice certain trends in spend and utilization, think about how your client might address those from every angle.

Use Hard Numbers to Encourage Your Client to Act

Show don’t tell. Provide context for every recommendation.

Show them what maintaining the status quo might cost them – higher drug spend, poor member health outcomes, etc.

Then paint the picture of what COULD be. Provide detailed insight into the strategic changes you’re recommending. And then provide context – in the form of hard data – that shows the projected positive impact of your recommendations.

Consider the following illustrative example:

Opportunity Identified400K life client
Increased utilization of GLP-1s through a combination of more diabetic Rxs being filled and providing coverage for weight loss.
Projected Outcomes without Plan Changes3% drug price inflation
3% utilization 
Estimated $265K additional spend in 2024
Potential RecommendationFormulary change to prefer lower cost GLP-1
Stringent UM criteria for weight loss indication
Required enrollment in a lifestyle modification program
Projected Outcomes with Plan Changes$1.15 per member per month (PMPM) savings
$5.5M plan savings
*For illustrative purposes only. Projected savings based on a 40 percent PA approval rate.

Don’t forget to have a plan on how to ease the potential impact on members. The member experience is critical, so spend the time to determine how many members will be affected and discuss exactly how those members will be supported before, during, and after a plan change.

Create a Polished Report In Minutes

Developing annual reports always involves sorting through an overwhelming amount of information. The time that could be spent consulting with clients is instead spent on generating reports and painstakingly piecing together client-ready presentations. Our Plan Review tool automates the creation of annual reports in just minutes. It draws on all pertinent data to create powerful, polished, reports with just a few clicks, saving you time and money.

Infographic of plan performance trends

2. Proactively Uncover Opportunities to Optimize Benefits

The typical process for annual plan reviews often relies on outdated information, which means you may be missing critical opportunities for plan optimization. Not only that, but survey results show that client satisfaction is linked to the timeliness of reporting. With Xevant, not only can you shorten the time it takes to prepare a plan review, but you can also share more timely, actionable information with your clients proactively using real-time alerts.

Xevant’s AlertLogic is a fully customizable tool that lets you track an endless number of metrics based on your unique goals. From monitoring members new to therapy, generic dispensing rates, and contract performance to tracking drug price inflation and beyond, Xevant will keep you informed of opportunities to optimize plan design in near-real time – leading to significant cost savings.

3. Remember the (Not So) Little Things

Just as important as crafting a comprehensive yet easy-to-follow presentation? The prep work and post-meeting communications. No matter how intuitive these efforts may seem, it’s important to pay them close attention.

  • Confirm the agenda ahead of time and verify all attendees. Make sure you’re covering everything your client wants to hear.
  • Review your client’s website for any new press releases or information that could be relevant to the conversation.
  • Carefully review your slides and content. Ensure there are no typos, incorrect data, or formatting issues. You should be able to speak to every data point on every slide.
  • Do a dry run. Use this time to ensure everyone on your team has a speaking part, determine how you will adjust if you run out of time, and ensure everyone feels comfortable speaking about their respective topics.
  • Guide your audience through the narrative. Make sure you’re bringing additional value beyond the words written on the slide (i.e., do not read the slide word for word – your clients can read).
  • After the meeting, schedule a debrief with your team and assign action items. Let the client know when they can expect an update from you and then follow through.

The annual plan review is your opportunity to show the value of your partnership. There should be no doubt in your client’s mind that you know them – their contract, their plan design, their unique goals. With Xevant’s industry-leading automated reporting tools, it’s easier than ever to level up your annual plan review meetings and show clients that you are best positioned to help them achieve their goals in an always-evolving market.

How can Xevant help level up your annual plan reviews? Ask us.

Source: https://www.wsj.com/health/wellness/stop-taking-ozempic-wegovy-weight-loss-c0e11316


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