key to Pharmaceutical Horizons? services is customization. Since no two
clients have the same needs, we help identify and define the programs and
services that will benefit each individual plan.
The knowledge and expertise of Pharmaceutical Horizons? staff in the area of pharmacy benefits is available to guide our clients in making informed choices when designing or modifying their prescription drug programs. We can also be a plan?s consulting pharmacist on demand.
Evaluation Level 1
A summary of plan performance vs. regional benchmarks allows for performance comparisons. Quarterly, we produce a set of eleven trend charts that graphically depict drug costs and use over a rolling 12-month period.
and Plan Management Reports:
Amount Paid PMPM = total charge - member copay x utilization
Rxs PMPM = number of Rxs dispensed per covered life each month
Amount Paid/Rx = total charge ? member copay
Average Drug Cost/Rx = allowed drug cost for both brands and generics
Average Dispensing Fee/Rx = service fee paid to pharmacy per Rx
Member Copayment/Rx = member?s share of cost for each Rx
Generic Index = ratio of actual substitution to potential substitution
Generic Substitution = generic dispensing as a percent of total Rxs
Brand Drug Cost = average cost of each brand drug per Rx
Generic drug cost = average cost of each generic drug per Rx
Total Charge/Rx = allowed drug cost + dispensing fee
Evaluation Level 2
This is a natural progression following identification of possible problems that show up during the quarterly review of the plan financial and management reports. We describe for client's changes in their drug class and product use and how this impacts plan costs. Comparison of the current year with the previous year helps identify costly areas and offers an opportunity to seek lower cost alternatives.
plan specific report indicating the top drugs dispensed for members by cost
plan specific report indicating the drug classes dispensed for members by cost
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