Response from Nathan Holman, vice president of information technology, RxBenefits.
How can we use data analytics to drive better decision making and lower costs in pharmacy benefits?Rising prescription drug costs are a significant concern for employers, who are struggling to reign in dramatically increasing pharmacy benefit spend while protecting the health of their members.
In fact, more than 60% of employers say their prescription drug and medical spend is costly and unsustainable, and spending on specialty medications is forecasted to continue increasing 15% year over year. However, many employers overpay an average of 14% per year for their pharmacy benefits simply due to misaligned pharmacy contract terms or a lack of a pharmacy contract altogether.
In addition, clinical misalignment results in employers overpaying by an incremental 5% to 10% per year. It’s essential that employers have full visibility into the actual performance of their plans in order to improve the health of their employee population at the lowest net cost.
Applying data analytics enables employers to evaluate and compare pharmacy benefits options as well as gain insights into plan performance and utilization in order to make better decisions. Advanced pharmacy data analytics can uncover any potential financial and clinical risks lurking beneath the prescription drug program’s surface, which can contribute to wasteful spending.
The insights provided can also reveal opportunities to introduce new clinical strategies that promote medication appropriateness and member safety and quality of life. Additionally, data analytics can be used to analyze the cost and member impact of any decisions before they’re made.
When applying data analytics to optimize a pharmacy benefits plan, the ideal approach begins with combining the employer’s complete pharmacy claims historical data with specialized expertise that addresses clinical risk areas and cost-savings opportunities.
Ultimately, optimizing pharmacy benefits with data analytics drives cost savings for employers and facilitates better health outcomes for members.