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Lower pharmacy costs using real-time data and insights
As pharmacy costs rise and complexity grows, small errors can result in large financial misses, loss of business, higher costs, and potential legal challenges. All stakeholders in the pharmacy value chain need data insights that improve access to affordable medications, lower costs, increase profitability, and minimize disputes.
Milliman SkySail® is a multi-use data analytics platform that ingests claims data from any source, rapidly analyzes it, and delivers actionable information to support claim summarization, repricing, guarantee management, RFP analysis, and more. It improves underwriting and bidding accuracy, increases sales success rates, reduces risk, and helps your analytics team work more efficiently.
Strengthen negotiations using reports that analyze real-time drug pricing trends and evaluate contractual exclusions.
Ensure contract compliance and use Milliman Dynamic Pharmacy Analytics data to revise contract language, improving the bottom line.
Flatten the learning curve for new hires and provide them with tools to make accurate reports for senior management.
Improve the accuracy and utility of your data automatically while maintaining the original dataset for reference.
Ingest pharmacy claims from anywhere in the pharmacy benefit industry. Using powerful machine learning technology, Milliman Dynamic Pharmacy Analytics accurately processes the data at up to 1M claims per minute. Apply modules and features to produce dynamic, in-depth analysis for a wide range of needs.
Using ClaimDNA technology, Milliman Dynamic Pharmacy Analytics cleans, ingests, analyzes, and presents data in a dynamic platform without ever losing the ability to drill into individual claims.
Choose from a variety of fully customizable reports that enable you to analyze what matters to your business. Milliman Dynamic Pharmacy Analytics can even interface directly with Microsoft Excel.
Quickly and accurately respond to RFPs using built-in underwriting tools. Create estimates based on a client-specified pharmacy network or toggle among different contractual terms to estimate impact.
View accurate, up-to-date information whenever you need it and adjust accurately prior to an end-of-year audit.
Review and summarize claims detail to forecast and estimate drug spend based on RFP requirements and contract rates.
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.
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.
Compare contracted discount rates and savings with real-time pharmaceutical claims experience reporting.
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