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Enable real-time pharmaceutical claims experience reporting with powerful analytics
Milliman’s MyRxConsultant™ is an online pharmacy claims reporting platform that enables users to accurately view their pharmacy claims experience in real time. Users can track their drug spend, utilization, member costs, average wholesale price, dispensing rate, contract performance, and more.
MyRxConsultant lets users compare their contracted discount rates and savings by processing their pharmacy claims data, generating pharmacy benefit costs and experience reports on demand.
MyRxConsultant offers transparent, timely, and accurate reporting that empowers users to make data-driven decisions to better manage their pharmacy benefit costs.
Users can view discounts, costs, and distribution of their pharmacy claims across four areas: mail, retail, retail 90, and specialty.
Users can visualize contract performance through a drilled-down list of key cost and discount metrics.
Plan managers can quickly see which drugs and drug classes are driving plan spend.
Users can see a snapshot of top drugs by utilization across all distribution channels.
Users have a cross-referenced view, which breaks down utilization and associated costs per category.
Provide transparency into your pharmacy claims experience, allowing you to review your Pharmacy Benefit Manager (PBM) invoices with confidence.
Empower your negotiations with PBM using data-driven insights that show areas of underperformance.
Leverage your claims data to monitor your pharmacy benefit performance against contract agreements in real time.
Leverage reports that provide insights on the top drugs, drug classes, prescribers, and members behind high cost.
Drill down to the member level and identify high utilization patterns using our Power BI-enabled reports.
View pharmacy spend and dispensing rates across distribution channels.
We are available to help clients audit their PBM arrangements to validate that the PBMs meet contractual integrity and financial obligations. We routinely perform audits of pharmacy claims, rebates, retiree drug subsidy, prescription drug event, performance guarantee, corporate compliance, and data validation.
We help clients write, negotiate, analyze, and audit their contracts with PBMs. We bring an understanding of the ongoing changes and current cost factors in the pharmacy benefits industry and use it to help clients obtain the most favorable contracts with the best pricing possible.
We help with vendor selection, including RFP development, PBM bidder selection, RFP fulfillment, proposal evaluation, and finalist selection.
We help clients create and analyze a robust pharmacy benefits plan model that also provides flexibility and affordability for both plan sponsor and plan members.
Once a PBM vendor has been selected, we provide PBM implementation oversight to ensure a smooth transition to the new PBM with minimal member disruption.
Our consultants can also work directly with a client’s PBM to provide improved economic control and a greater focus on quality of care and service to the plan’s members. This can help ensure the transparency of financial, clinical, and operational processes of the PBM operations, and also provides a way to manage cost with the integration of medical guidelines, disease management, wellness, and other clinical-based programs. On-going support and management we routinely provide to our clients includes reporting (monthly, quarterly, and ad-hoc), attendance at PBM meetings and presentations, independent assessments of cost and utilization statistics, and market checks for pricing terms for specialty and traditional medications.
In this series of articles, Milliman consultants explore a range of issues relating to PBM best practices.
Is your PBM delivering ROI? Learn how to improve your RFP and contracting processes to get more value from the relationship.
One of the most important ways plan sponsors can lower healthcare costs without significantly changing their benefits is to look for opportunities to improve their pharmacy benefit manager (PBM) contract.
Effective PBM contracting can have a significant impact on the cost of prescription-drug benefits.
This paper looks at the pharmacy benefit manager (PBM) implementation process and identifies key items to consider for a successful PBM implementation, including pre- and post-implementation activities.
Prescription drug costs have increased dramatically in recent years with double-digit average wholesale price (AWP) inflation trends becoming common.
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