Third Line of Defense
Competitive Delivery Channels
Powerful network contacting and a dynamic MAC list with auditing protocols truly targets inconsistencies in the pharmacy network.
1. Detailed pharmacy profiling: PharmPix’s clinicians profile pharmacies with sufficient volume in the following criteria:
- % of refills
- % of reversal of refills
- Cost per unique member
- RXs per unique member
- % of partial fills
- DUR success rates
We have created benchmarks based on industry knowledge and the actual performance of our complete network for each criterion shown above.
Outliers are defined based on industry averages, which are then targeted for desk or field audit depending on the documented criteria. There is also a surveillance program that sends communications to targeted outlier pharmacies, to keep them in line.
2. Competitive Mail Order Contracts: PharmPix believes in using an external mail service provider in order to drive healthy price competition for our client plan sponsors. PharmPix also continues to review the latest, best-in-class methods for managing chronic medication delivery via mail service to provide our plan sponsor clients with up-to-date technology, improved member services and quality of care.
3. Competitive specialty pharmacy contracting with Specialty PA Program, including infused drugs: We believe in providing our clients with several options for Specialty service providers in order to drive a healthy price competition for our client plan sponsors.
In some cases, we also believe that certain therapies are better filled in a retail pharmacy when fraud and abuse might be a concern. PharmPix also continues to review the latest, best-in-class methods for managing specialty pharmaceutical delivery in order to provide our plan sponsor clients with up to date technology, member services and quality of care.
In addition to our distribution partnerships, we monitor the approval rate of the PA program. We believe that a program with more than 87% approval rate will not achieve the desirable ROI of 2.5:1. Also, our specialty program monitors members from the PA throughout the length of the usage based on effectiveness and safety