Whether you’re gearing up for bid season or in the thick of it, you’re aware of the intricacies of evaluating multiple offers for pharmacy benefit management (PBM) services and determining which one will yield the best result. It’s a critical and time-consuming process to get right.
You must understand complex regulatory requirements, ensure alignment with organizational goals, and – what often takes the most time – delve into the nuances of pricing structures.
The good news? Automation tools exist to streamline your efforts, making it easier than ever to evaluate PBM proposals in less time and with greater accuracy.
Navigating the Intricacies of Pricing Proposals
Understanding the true cost of medications within a PBM arrangement requires a keen eye for detail and – without the right technology – hours (or days!) spent pouring over detailed spreadsheets.
Pricing proposals include discounts and rebates that, at face value, may seem to tip the scales between PBM offers. However, when you factor in elements like excluded claims*, the numbers are not as straightforward as they seem.
Consider the following example of rebate guarantees from two different PBMs. Without factoring in excluded claims, there seems to be a clear winner. PBM 2 is offering a higher rate per rebate-eligible brand drug at $170, saving the client an additional $30,000 over PBM 1.
But when you take a closer look at the excluded claims, the “winning” offer isn’t as obvious. As you can see in the table below, PBM 2 excludes 500 claims, while PBM 1 excludes 200. These exclusions make the annual claim count lower in PBM 2’s offer – meaning fewer claims are eligible to receive a rebate.
Once you apply the excluded claims to the rebate-eligible claim count, it becomes clear that PBM 1 – despite having a lower rebate guarantee of $155 – saves the client more money.
It’s critical to uncover this level of detail quickly. But without the right tools, you’re most likely spending countless hours creating spreadsheets and crunching numbers to determine which offer is in your or your client’s best interests.
Automate This Process to Save Time and Money
With the right technology, such as Xevant’s BidLogic tool, you can automate all this work and streamline your entire bid review process. Think of it like your own team of analysts, taking the work off your plate and producing a comprehensive, error-free pricing evaluation in minutes.
So, you can spend time consulting with your clients to help them make the most informed decision – not sifting through data and drowning in spreadsheets.
And, once the bid process is over, you can use automation tools to monitor the resulting contract in real time, keeping all stakeholders accountable to agreed-upon rates. At the same time, you can proactively identify cost savings to keep you and your clients ahead of the fast-changing pharmacy landscape.
How can you identify the best PBM pricing offer faster? Ask us.
*PBMs exclude claims from rebates for many reasons, some of which include vaccines, compound drugs, direct member reimbursement claims, authorized generics, and cosmetic drugs. Note: In the hypothetical rebate example, to determine the annual rebate amount, we multiplied the minimum rebate guarantee amount by the annual claim count.
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