News & Insights
Check out EpiphanyRx’s latest Fast Five Series post!
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We’re sharing 5 quick industry insights about pharmacy benefits.
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Employers are tired of feeling confused or overwhelmed by the data provided from their pharmacy benefit manager (PBM). In our latest Fast Five post, we’re uncovering what makes up a stellar reporting package from a PBM, including essential data points for employer groups and the pitfalls of overwhelming clients with too much data. Read on to learn more.
1. What does a good reporting package for employers look like?
A good reporting package encompasses more than just delivering data. In addition to providing a presentation or prepared documents on all the important facts and figures, it should open the door to meaningful dialogue between the PBM and the client.
The PBM should provide personalized touchpoints to ensure that clients understand every aspect of the reporting package. These conversations should be proactive, rather than reactive, to allow for explanations and problem-solving to resolve issues before they arise. Each client is unique and requires a tailored reporting solution based on their needs and time constraints. Some clients may be okay with a high-level overview. Others may need more help in understanding what the data means. Providing clients with what works best for them allows for the development of a collaborative and productive relationship between the PBM and client.
If possible, clinical savings should be highlighted, with category or drug-specific stories shared if they add value to the understanding of why spend and trend are increasing or decreasing. With a streamlined reporting process focused on the most relevant insights, clients can grasp the essential takeaways without drowning in a sea of data.
2. What key data points are most relevant to employer groups?
Employer groups need concise yet comprehensive insights to make informed decisions about their healthcare plans. Drug trends should be identified and explained. Key data points include:
- Total + Plan Paid PMPM
- Where are costs trending (when accounting for shifts in membership)?
- Utilization/Member Behavior Patterns (Utilization PMPY or PMPM)
- Are members using more or fewer claims on average?
- What types of products are members using?
- What prescriptions are being filled for new plan members vs. existing members?
- How did members leaving the plan impact trends?
- Spend/Average Drug Cost (Ingredient Cost per Rx)
- Are average claim costs increasing or decreasing?
- What drugs are being newly utilized by the plan?
- What generics have recently entered the market that have been implemented by members?
- What pipeline is foreseen coming down the road?
- What does drug inflation look like?
- What is the comparison of specialty vs. traditional products used?
By providing clear explanations of trends and highlighting the value achieved, PBMs can encourage their clients to optimize new or different healthcare strategies including programs or products they may not be leveraging to reduce costs.
3. What mistakes do some PBMs make in data reporting?
One common mistake among PBMs is providing too much data, which can confuse and overwhelm clients, particularly smaller employers. Clarity and transparency are often not prioritized, and the result is “information overload”.
Additionally, not every PBM is transparent or “pass-through”, meaning that rebates and discounts are not passed back to the client. By not disclosing how rebates are processed and specific rebate amounts, clients are unable to see the savings they are missing out on if they were to transition to a pass-through PBM.
If you are working with a truly pass-through PBM, reporting will also be helpful in measuring performance and reconciling minimum guarantees. More importantly, a pass-through PBM should not be managing performance to the guarantees but rather passing-through the full value including improvements on an ongoing basis. We recommend asking your PBM if they reconcile to actual performance or guaranteed performance.
Given the ever-changing market dynamics, the opposite is important as well: a PBM that is truly aligned with their clients and members should be forthcoming about increases in costs and provide potential cost-containment strategies.
4. What is the risk of providing too much data to a client?
Unfortunately providing too much data is a common PBM practice exhibited by the some of the larger PBMs in the industry. Overwhelming clients with excessive information can hinder understanding. The critical stories and important takeaways from the data are lost in a multitude of presentation slides, charts, and graphs. While the data is provided, the “why” behind it is uncertain, and without proper understanding, clients will not know how to plan or prioritize to meet their goals for the upcoming years.
5. Why is a transparent, pass-through PBM a better solution when it comes to providing reporting and analytics?
A client and member-focused transparent, pass-through PBM bolsters a commitment to helping clients and members save money while accessing the care they need to lead healthier lives. A transparent PBM like EpiphanyRx provides clients with the confidence that they are receiving the full value from their benefits package.
We recommend a PBM partner with a strong reporting solution that includes clearer storytelling, collaboration, meaningful conversations, and proactive client engagement without hidden agendas or hidden revenue streams like spread pricing. It is important to prioritize quality over quantity, ensuring that clients receive concise yet impactful insights to drive informed decision-making. Rebates and discounts are passed back to the client, and rebate reporting is provided for clients to see how much they are saving.
“At EpiphanyRx, we strive to have clear, coherent client reporting that easily highlights the stories that matter to our clients.” – Ian Holmquist, Director of Analytics
At EpiphanyRx, we believe that effective reporting is not just about delivering data. It is about empowering clients with insights to confidently navigate the complexities of pharmacy benefit management.
Lastly, another advantage of working with a transparent PBM you can trust is our firm position that selling a client’s data to outside entities for undisclosed revenue is inappropriate and unethical. EpiphanyRx does not sell client data to any outside source or disclose such data to any business entity that is not engaged in a business relationship providing pharmaceutical or operational support for our programs.
We offer a fully transparent reporting package with the clarity, value, and accessibility that employers deserve.
To learn more, contact Jonathan Har-Even, VP of Sales, at jonathan.har-even@epiphanyrx.com or request a proposal by contacting rfp@epiphanyrx.com.