Management Reporting
The SPS staff members are experts in dealing with large data files. Knowing what to look for and how to display results are key to any data analysis. We can present reports that are non-standard to the PBM industry.
The SPS staff members are experts in dealing with large data files. Knowing what to look for and how to display results are key to any data analysis. We can present reports that are non-standard to the PBM industry.
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Strategic Pharmacy Solutions has developed ProbeRx® reporting- a set of unique reports generated out of our audit software tool. Although the report generator can produce any “ad-hoc” report desired, SPS has designed reports that offer the client insights to the Plan’s financial results, the PBM processing procedures, Plan Design effectiveness, Member Utilization and potential design changes to produce savings.
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Our ProbeRx® Audit Reports will define the audit results. The Management Reports will help manage the pharmacy expense and answer questions your PBM has not covered. The reports listed below have summaries at the top and rows of detail for all individual discrepant claims.
Selected Audit Reporting:
Selected Management Reports:
Selected Audit Reporting:
- Executive Summary- the Audit Summary is generated automatically with each audit run, individual claims are listed and given to the PBM. To help with a formal client report is the Executive Audit Summary, this report gives the results in the “types” of errors found, giving a better display of general processing issues addressed in the Summary. This report is the main summary that will be discussed with the client as the final audit result. The report will be the focus of discussions with PBM concerning discrepancies in general. The software backs up the summary with separate files of individual discrepant claims for each category highlighted be the summary. Using the summary, a narrative in Word will be written and given to the client for further description detail.
- Quantity Limits Report- Plan design limitations of “quantity over a specific time” are being processed differently by the various PBMs. This report highlights the processing discrepancies and totals the financial impact.
- Step Therapy Report- Drugs that require a “pre-requisite” therapy be tried before a usually higher priced drug is allowed are often not processed according to plan design. This report highlights the processing discrepancies and totals the financial impact.
- Copay Report- This report compares the input to the actual data copay assignments and gives the results as claims that hit the expected copay, but also those that were under and over the assigned copay. The report shows the financial impacts and number of claims in each category.
- RTS Summary- “Refill Too Soon” is an error found by the program. Because the single claim found discrepant is related to previous claim or claims, the research or verification of discrepancy needs to be compared to the related claims filled by the member. This report produces “member profiles” of the utilization of the drug in question. The report does the research needed by showing the Dates of Service and highlighting the discrepant claim as being filled prior to a set % of Days Supply.
Selected Management Reports:
- Key Statistics Report- Although your PBM has a series of reports that deal with the plan statistics, this report goes further by giving information on generic MAC utilization, AWP % discount results of MAC, non-MAC, overall Generics, Formulary and non-Formulary Brand and overall Brand. It tracks a Copay to Cost ratio that places a value on the effectiveness of the copay. Best of all, the report is concise and easily understood
- Trend Summary Report- This report utilizes the past two years of data to create a picture of drug spend trend. The report shows a percentage trend on the same important statistics of the Key Stat Report - comparing the current month’s results to the same month of last year and a comparison of the current “year to date” results to the same period of last year.
- Top Therapy Report- This report uses the Medispan assignment of Therapy Category to rank therapy groups by descending cost to the plan. The report shows the number of claims, dollar spent, a description of the therapy and your most common drug in the category. This report is very useful in targeting the areas to concentrate efforts to lower drug spend.
- Prior Authorization Report- This report totals for the usual reasons the Plan or PBM has allowed a PA but also shows the financial impact of various overrides. Conclusions can be made on possible corrections to PBM PA procedures.
- Duplicate Therapy Report- Often members will have similar drugs that are intended, but can also receive unintended duplicate therapies from multiple physicians and multiple pharmacies. This report will show duplications of therapy class. Our clinical pharmacist or your staff can review this report for possible notification to the physicians involved.
- DAW Report- When the plan is considered “generics preferred” and a brand is demanded and dispensed, a penalty should be applied to the member copay. The DAW assignment by the pharmacist and the DAW processing procedures of the PBM will have a huge impact on the financial outcome. This report defines the records the financial impact of processing results.
- MAC Detail Report- The Key Stat Report described earlier gives the statistics of cost and discount of the applied MAC List. This report shows the detail and financial impact, by drug, when the PBM missed applying the MAC.
- Specialty Opportunity Report- Your PBM may have you set up with a “Specialty Pharmacy”. Often the pricing allowed is also better than the regular network pharmacy. This report is designed to isolate the claims for these chronic drugs filled at local pharmacies and shows the financial impact or savings potential of a move to the Specialty Pharmacy.
- Rebate Count- this is a simple summation count of paid claims only from the database, totaled into calendar quarters by Retail, 90 Day Retail, Mail and Specialty. This report is used to compare the guaranteed rebate per paid claim for a client’s contract.
- Potential Abuse Report- This report was designed around a table of medications usually involved with abuse. Using the table, the program will inspect the database of claims for cases where the member is receiving addictive medications from multiple physicians, multiple pharmacies or in excessive quantities. The daily use by the member of the drug in question is compared to a First DataBank reference of Maximum Daily Dosage. A detailed list of potential misused claims is reported by Member ID. While the report can easily be run, interpretation by a clinical professional is required before any misuse can be assumed. No action or declaration should be made until a thorough case study is done involving the member, the dispensing pharmacy and the prescribing physician.
- Member Compliance Report- This report utilizes the First DataBank or Medispan assignments per drug of “Maintenance” to flag drug use that would need to be consistent for the member’s best health. A “percentage of daily used” is used as a threshold to compare the member’s history to an accepted drug regimen. Programs of member education or notification can be initiated for outlying members.
- Ad Hoc Reporting- With your database of claims in the system, Our system also has an “export” feature that has the ability to generate specific reports on any selected claim details of member, drug, category or source. This flexibility allows the user to design and produce literally any desired report on the data. Any report design can then be saved as a standard report.