PSG - Pharmaceutical Strategies Group

“Our PSG account services director is a dream to work with. The availability of a pharmacist for client contact/ communications is highly appreciated and lends tremendous credibility to the vendor. Keep up the good work!”

—Senior Account Manager, Third-Party Benefit Administrator

Clinical Support

PSG has eight clinical pharmacists, giving us more clinical consulting capability than many PBMs and more than any other pharmacy benefit consulting firm in the country. Our clinicians are an integral part of the work we do to help clients reduce drug trend (annual rate of cost increase) in their pharmacy programs, which is key to maintaining a quality benefits program. Our clients enjoy trends significantly below the national average as a result of our focus in this area. All of our pharmacists have 10 or more years experience in the field. This real-life experience ensures delivery of practical solutions with a minimum amount of member disruption.

PSG’s clinical support services include:

  • Consultation on benefit design, coverage and plan limits.
  • Population benchmarking and evaluation.
  • Review of claims and utilization data.
  • Formulary evaluation.
  • Cost-reduction opportunity identification.
    • Therapeutic class evaluation.
    • Disease target and intervention strategies.
    • Generic substitution, OTC and mail service utilization.
  • Facilitate maximum value from PBM clinical services.
    • Alignment of disease management and intervention strategies with member population.
    • Assistance with reporting of meaningful and actionable information on each client’s program.
    • Interpretation of pharmacy utilization and clinical reports.
    • Ongoing education, advice and communication assistance with changes in pharmaceutical product availability.

Plan Performance Analysis and Benchmarking

  • Financial performance and trends.
  • Utilization.
  • Effectiveness of cost-management and clinical protocols.
  • Plan design.
  • Operational performance.
  • Contract evaluation (vendor execution against performance standards).

Predicting Future Program Costs

To accurately assess and predict future claim costs in our client’s population, PSG uses claims-level detail to quantify the current impact of pharmaceuticals and to forecast potential growth in utilization and spend. PSG’s forecasting models include key assumptions regarding overall utilization, channel utilization, generic dispense rates, growth in key therapeutic classes, specialty drug utilization, anticipated impact of new drug launches (including generics), and many other factors.  These assumptions are driven from monitoring industry trends, data mined from our data warehouse, and client-specific data/trend analysis.

In addition, our technology platform allows our clinical pharmacists and financial analysts to conduct a myriad of plan design modeling scenarios, including:

  • Evaluating the impact of changes to formulary composition.
  • Evaluating the impact of drug positioning strategies for over-the-counter (OTC) drugs, drugs coming off patent, and how brand and specialty product launches could impact future costs.
  • Measuring the potential impact of programs designed to influence drug mix (e.g., plan design, member education, and other program components).
  • Calculating the value of generic conversion programs.
  • Monitoring the status of prescription fraud and abuse programs.
  • Providing an unbiased interpretation of all clinical program recommendations and strategies offered by the PBM.
  • Providing analysis around specialty pharmacy making recommendations around coverage for current specialty medications and helping clients to predict costs and utilization in the future.

Formulary Management & Opportunity Analysis

PBM formulary strategy has a material impact on both member satisfaction and overall costs.  PSG has extensive experience evaluating the effectiveness of PBM formularies.  The end result is a cost-effectiveness assessment of the PBM’s formulary approach, coupled with detailed recommendations for how to improve any shortcomings in the program.  Our clinical analyses identify ways to drive to more cost effective medications through better product selection (e.g., generics, OTCs, therapeutic alternatives) and channel delivery (e.g., mail order, chains, etc.).

PSG recognizes the tremendous importance of clinical program initiatives and deploys experienced clinical pharmacy professionals to assist its clients in developing and deploying best-in-class clinical intervention approaches. Clinical support services are defined specifically in conjunction with each client, but typically include services such as:

  1. Providing independent review of formularies to ensure that our clients are benefitting from a low net cost strategy.
  2. Identifying opportunities to improve clinical performance of the plan through better drug selection strategies and better compliance strategies.
  3. Assisting with measuring the impact of suggested clinical program and/or formulary changes over time.

 

© 2010 PSG - Pharmaceutical Strategies Group