Innovative Analytics to Reduce Pharmacy Costs

Innovative Analytics to Reduce Pharmacy Costs

 

Quest Analytics Group assists clients in decreasing their pharmacy spend by utilizing the Quest Rx Dashboard, which performs a detailed analysis on paid claims over a 12-month period. Smaller time periods can be utilized for the analysis, but having data for a full year eliminates the influence of seasonal medications. The analysis is not the typical comparison of drug discounts clients are used to receiving from other consulting organizations

The Quest Rx-Dashboard is a proprietary analytical snapshot of the core economics of a client’s pharmacy benefit. The Rx Dashboard derives a benchmark from a client’s paid pharmacy claims against other groups of similar size, geographic location and drug mix. In addition, it will reveal the actual average script price, discounts from national wholesale price averages, brand/generic drug dispensing rates, specialty drug discounts, member copays and vaccine utilization, along with potential savings opportunities. 

In 2019, clients of Quest Analytics Group continued to see a decrease in their pharmacy costs, increased member satisfaction and decreased uncertainty of their ongoing pharmacy costs.

Rx Dashboard Sample

  2018 Average Script Price (ASP) Trends


What is the Cost to perform the Rx Dashboard? 

If you cover over 500 members, there is no charge to benchmark your current pharmacy benefit. 

What is the Turn Around Time to Complete the Claim Analysis?

After steps are taken to ensure the confidentiality of your member data, the Rx Dashboard takes approximately 48 hours to perform.  

QuestRx-RFP is Complete Project Management of the PBM Proposal and Selection Process. 

QuestRx-RFP alerts multiple Pharmacy Benefit Managers (PBM’s) of the opportunity you control. It fosters competition to lower your plan cost. Our unique Average Script Price (ASP) agreement lowers future price-inflation risk that “pass through” and “fixed discount” proposals place on the buyer. Your result is a lower cost plan that is competitive with the market, has lower risk to price inflation and has more predictable future costs. 

Are There Fees Associated to Quest Performing an RFP? 

Generally, there is no client out-of-pocket or upfront cost. The fees to perform the RFP are paid by the client selected PBM.  

 

Why Use QuestRx RFP? 

The QuestRx RFP process saves you time and gives you the power to negotiate. It allows HR and procurement professionals to remain focused on their internal operations, while we manage all activities and communications. Program management continues through the bid evaluation process including, PBM presentations made to the client, proposal screening and creation/review of the final PBM contract. Quest ensures that their client contracts are constructed to be fully auditable. In addition, independent audit services are included and scheduled annually. 

How Effective is the QuestRx RFP Process? 

Over the past year, Quest Analytics Group has continued to lower their clients’ pharmacy benefit costs, increased members service levels and decreased the uncertainty of future pharmacy costs.

 

Contact us to learn more

Average Script Price (ASP)

Quest Analytics Group created the pharmacy benefit Average Script Price (ASP) model in 2010. Since then, many clients have saved millions of dollars utilizing this pricing structure for their pharmacy benefit contracting. ASP reduces the opportunity for manipulation of payers’ pharmacy performance by the PBM. This pricing model ensures Quest clients receive market competitive pricing and the contract is 100% auditable.

Data Analytics and Reporting

Quest Analytics Group provides actionable and tailored reporting to fit our clients’ needs and strategy. We offer a suite of reports to guide our clients during the RFP process, provide an understanding on how their pharmacy benefit is performing and PBM annual audit reports. In addition, a team member from Quest Analytics Group will provide an overview of the opportunities to enhance and decrease costs associated to your pharmacy benefit.

Quest Pharmacy Savings App

Quest Analytics Group provides a national pharmacy savings app to reduce the cost of medications for individuals who don’t have pharmacy benefits and provide discounts for medications that are not covered by an employer benefit design. Utilization of the Quest  Pharmacy Savings App can provide savings up to 15% on brand drugs and 75% on generic drugs. The Quest  Pharmacy Savings App is accepted at more than 39,000 pharmacies, including CVS and Wal-Mart.

Quest Pharmacy Savings is a mobile app that will make the use extremely easy for your members.

Why use ours over other discount cards:

  • Provides options to price check, locate a pharmacy and 24-hour customer support
  • Competitive discounts and reduce plan costs
  • Monthly reporting
  • Offers membership affordable prescriptions during benefit wait period or when medications are not covered by benefit.

PBM Claim and Contract Audit

Quest Analytics Group utilizes a propriety technology to analyze 100% of the pharmacy claims based on the PBM contract terms. Many payers do not perform audits on their pharmacy claims or contracts during the life of the contract, they rely on the PBM to self-report their findings. Performing an annual audit holds the PBM accountable, identifies errors and ensures the PBM adheres to the agreed contract terms.

Implementation Assistance

Pharmacy implementations are very time consuming and we will be with you every step of the way to ensure that everything is implemented based on the agreed upon RFP terms. PBM implementation experts will review and provide guidance on PBM plan design documents, work with the incumbent to ensure data files (eligibility, pharmacy claims and open mail order refills) are shared to prevent any disruption of the population, and  attend meetings with client selected PBM.

Request for Proposal (RFP) and Pharmacy Benefit Management (PBM) Contracting

Quest Analytics Group leverages their expertise to eliminate the complexities of the RFP and PBM contracting process for brokers and self-insured employers. Each client is provided a customized and comprehensive approach to ensure your objectives are met. They are able to provide economical modeling for all pricing scenarios provided by each PBM during the bidding process that allows for an apples to apples comparison.

PBM contracting is a complicated process for anyone to encounter. Quest Analytics Group assures that the client is protected by the agreed contract terms. They ensure contract terms are clean and well defined, performance can be accurately audited and enforced, plus will perform quarterly/annual audits.

Specialty Drug Management

While we see a decrease in spend for traditional drugs, specialty drug development and spend is at an all-time high accounting for over 45% of total pharmacy spend. Specialty drugs are used to treat conditions such as cancer, HIV, Multiple Sclerosis and Hepatitis C. Payers need to have a full understanding of their specialty drug spend and implement a multi-facet approach to manage specialty spend while ensuring the quality of care is not impacted to their population.

Quest Analytics Group provides a solution to assist clients in managing drug spend in the medical and pharmacy benefit. The Quest Specialty Drug Management Program goals are to reduce specialty drug waste due to over utilization, use of inappropriate drug channel, off label prescribing and billing errors. The Quest Specialty Drug Management program has saved clients 25-30% on their medical and pharmacy specialty drug spend.