“I knew we hired the best!”
— Sr. Benefits Specialist for a state utilities company.
PSG knows that effective pharmacy benefit programs can only manage what they can measure. To meet this vital need, we have invested a significant amount of resources into developing what we believe is the industry’s most robust data warehousing, modeling, comparative analysis, and reporting platform. Below, we outline some of the highlights of PSG’s technical resources, from both a human and technological standpoint.
PSG’s pricing and data analysis function is managed by highly-experienced team of industry experts. Each of the professionals in this group is a veteran insider from the PBM industry with direct experience and expertise in pricing, data warehousing, benchmarking, and prescription claims auditing. PSG’s technological capabilities have been developed and designed internally as a direct result of this combined, real-world experience to cut through the fog of pharmacy data, supply chain practices, and financials to provide our clients with the information they need to make informed, clear decisions.
PSG’s applications were built by a team of industry professionals with extensive knowledge of the management and analysis of pharmacy benefit program data. This team includes information technology (IT) professionals who previously held director-level positions with the nation’s “Big Three” PBMs where they were engaged in a wide variety of book-of-business and client-specific data analysis and reporting initiatives. Their background and firsthand experience ensures that PSG’s IT infrastructure is able to handle the complexities inherent in pharmaceutical pricing and reporting projects. We have analyzed and normalized claims file information from over 20 different PBMs and actively collect, sort, analyze, and report data from the top PBMs in the country. Because we know from experience what our clients need to make informed decisions, we believe our data analysis and reporting bring a much greater degree of clarity and transparency than what PBMs usually provide themselves.
This team also includes former underwriting and financial insiders from the “Big Three” PBMs giving PSG intimate knowledge of how PBMs derive and structure their price offerings. Our technological team understands intimately the pricing strategies and practices of PBMs, and are astutely aware of how to measure revenue and margin derived by PBMs on their client base.
PSG’s data analysis, PBM compliance review services, and reporting operate on internally-developed software applications based in SQL. Our proprietary platform enables PSG to provide:
Pharmacy benefit management contracts and pricing methods can be complex. PSG purchases third-party software to ensure that the assignment of pricing sources is appropriate based on claims-specific data feeds. In addition to ensuring accuracy, this external pricing source allows us to model various alternative pricing structures as requested by our clients (e.g., WAC-based pricing, etc.). We regularly monitor external pricing sources to ensure that PBMs are responding correctly to changes in the pharmaceutical supply chain (e.g., quickly adding products to their MAC lists once there are multiple manufactures available).
While PBMs have the ability to collect robust information based on pharmacy claims transactions, the reporting options available through their standard reporting templates can be limited. PSG’s financial and reporting teams are experts in developing customized reports to allow our clients to easily and effectively measure the overall performance of their pharmacy program.
PSG’s clients are interested in knowing whether their PBM is measuring up to the financial terms of their contract. Our data and reporting team has built a robust financial verification tool to ensure that PBM pricing protocols are adjudicating in strict accordance with the contract. The accurate interpretation of contract terms by an experienced PSG underwriter, coupled with a detailed claim-by-claim analysis of historical client utilization data, forms the basis of our pricing compliance report. The result of the pricing compliance analysis is a compliance report that demonstrates whether the PBM has lived up to the financial terms of the agreement, while identifying any potential sources of variance. PSG also routinely conducts claim-by-claim analysis of our clients’ utilization data to confirm that designated plan designs are being accurately administered by the PBM.
PSG’s data warehousing solution allows us to identify and report benchmarks across our book of business. This greatly benefits our clients by offering a broader scope of comparisons (rather than just book of business values from a single PBM). In part, our clients use our benchmarking services to various degrees to evaluate:
PSG’s data warehousing platform ensures that our consultants and clinical pharmacists have the right information at their fingertips to effectively evaluate every aspect of our client’s pharmacy program performance. Our consultants utilize the data warehouse to support a variety of custom evaluations.
PSG is also able to assist our clients with accurately forecasting future drug costs. We use claims-level detail to quantify the current impact of pharmaceuticals within each client’s beneficiary population to project potential growth in both utilization and spend. PSG’s forecasting models include key assumptions pertaining, in part, to:
These assumptions are driven from monitoring industry trends, data mined from our warehouse, and client-specific data/trend observations as appropriate. And, in addition to forecasting future drug spend, our technology platform allows our clinical pharmacists and financial analysts to conduct a wide variety of plan design modeling scenarios, including:
The technology platform PSG has developed, and the human resources available to obtain maximum value from the technology, has allowed us to create a pharmacy data analysis and reporting platform that is best-in-class in the pharmacy benefit consulting world.
© 2010 PSG - Pharmaceutical Strategies Group