Use case

Utilization Management

The Concern

I have so many members and their prescription needs are constantly changing. It’s nearly impossible for me to analyze, in real-time, utilization performance let alone make needed adjustments. I don’t know if the actual utilization is better than or worse than I was expecting. Creating spreadsheets to analyze the data is time consuming and can lead to errors because of manual processes. Using stale or outdated information doesn’t allow me to change, modify, manage, or impact performance and cost.

The XEVANT Solution

Xevant’s automated process will evaluate your plans’ utilization in minutes. You can set utilization expectations and then run reports as often as you would like to measure performance. These reports can be set up in AlertLogic so you can get daily emails when performance is outside your parameters. Additionally, you can take advantage of some pre-defined utilization measures already in the Xevant platform.

The Xevant Result

1

Brand Plan Paid

Shows the total plan paid amount for brand drugs, along with percentage increases or decreases over the previous period.

2

Generic Plan Paid

Shows the total plan paid amount for generic drugs, along with percentage increase or decrease over the previous period.

3

Retail 90 Plan Paid

Shows the total plan paid amount attributed to those claims filled through a pharmacy for over 83 days as designated as a maintenance medication.

4

Mail Order Plan Paid

Mail Order Plan Paid
Shows the total plan paid amount attributed to those claims filled through a mail order pharmacy.

5

Generic Dispensing 
Rate or GDR

Shows the dispensing rate or GDR. GDR is the percent of total claims represented by generic drugs. The GDR equals the number of generic claims divided by the total of all claims.

Xevant’s utilization reporting provides you meaningful quick filters, breaking out brand/generic, all channels, specialty, and formulary. You can “drill down” to get even more granular information.

The Xevant How to:

1. Log into Xevant
2. Open the tab on the left-hand side
3. Go to ScripLogic
4. Click Utilization
5. From here, you can view Scorecard, Plan Paid, Channel, or Product Mix
6. View each tab for different analytics regarding utilization

Ready to get started?