Cost Impact Initiatives
Hylis Pharmacy Solutions can detect the deceptive spread pricing financial margin practices of PBMs in order to drive cost savings for plan sponsors. With sister company Wonderbox Technologies’ world-class software, and our expert analysis of your pharmacy claims data, we identify instances of inflated average wholesale pricing (AWPs), repackaging, up-coding generics as brands, and private label generic programs. We can also perform a comprehensive analysis of pricing discounts against comparable pricing in the market. In most cases, plan sponsors realize a significant cost reduction without a change to their program’s benefit design.
With therapeutic category analysis of your pharmacy claims data, Hylis Pharmacy Solutions can identify current and future opportunities for cost reduction. We utilize sister company Wonderbox Technologies’ world-class software to uncover the effect of aberrant therapeutic patterns on your prescription drug program and recommend changes to your plan design. We can also project the financial impact of clinical changes to your plan such as use of an economic formulary rather than preferred drug lists, voluntary to mandatory generic programs, and the cost savings associated with clinical management initiatives. While these initiatives do require a benefit design change in most cases, the current and future cost savings significantly outweigh the investment in plan change.
Medication Therapy Management
Using advanced data analytics powered by sister company Wonderbox Technologies’ world-class technology, Hylis Pharmacy Solutions uncovers the cost savings potential within medication therapy management. These initiatives include:
- Creation of patient medication profiles to identify aberrant high utilizers and complex patients in order to access clinical appropriateness, suspicious activities and potential fraud.
- Identification of conflicting physician prescribing of medications
- Analysis of Utilization by Disease State by Severity within Disease State to drive improved forecasting of total cost over standard age/sex cost projection methods.
As part of our comprehensive suite of cost reduction solutions, Hylis Pharmacy Solutions can provide claims adjudication and contract compliance auditing of your current PBM. Our audits ensure appropriate discounts, clinical management and prior authorization contract compliance and rebate evaluations. To meet each client’s individual business needs, we can perform audits on a retrospective basis or on a weekly claims cycle basis. Our auditing services are an easy yet effective solution for clients to monitor compliance and to identify fraud, waste and abuse within their prescription drug benefit program.