Quest Analytics Group offers customized solutions to manage your prescription benefit and achieve high cost savings.
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 percent auditable.
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 percent 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 clients that will help control specialty drug spend in the medical and pharmacy benefit. The Quest Specialty Drug Management Program goals are reduce specialty drug waste due to over utilization, use of inappropriate drug channel, off label prescribing and billing and billing errors. The Quest Specialty Drug Management program has saved clients 25-30 percent on their medical and pharmacy specialty drug spend.
Request for Proposal (RFP) and Pharmacy Benefit Management (PBM) contracting
Quest Analytics Group leverages their expertise to simplify the RFP and PBM contracting process for brokers and self-insured employers. Each client receives a customized and comprehensive solution to ensure our clients’ objectives are met. Quest provides economical modeling for pricing scenarios based on the terms and conditions submitted by each bidder. In addition, strict rules are applied across all submission to achieve a level playing field, allowing payers to understand the economics of each offering evaluated in the RFP process. PBM contracting is a rather complicated process for anyone to encounter. Quest Analytics Groups has pre-negotiated contracts with PBMs that guarantee 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.
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.
PBM Claim and Contract Audit
Quest Analytics Group utilizes a propriety technology to analyze 100 percent 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 billing errors and ensures the PBM adheres to the agreed contract terms.
Quest Pharmacy Savings Card
Quest Analytics Group provides a national pharmacy savings card to reduce the cost of medications for individuals who don’t have pharmacy benefits and provides discounts for medications that are not covered by an employer benefit design. Utilization of the Quest Savings Card can provide savings up to 15 percent on brand drugs and 75 percent on generic drugs. The Quest Savings Card is accepted at more than 39,000 pharmacies, including CVS and Wal-Mart.
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 during the RFP process.