Cutting edge Pharmacy Benefit Management

1. Integrity RX PBM Training
6-5-2012

2. Today’s Agenda
• PBM Opportunity
• PBM – Process and Protocol
• PBM – Who, what, How and When
• Questions and Answers

3. PBM Opportunity
Market
• Any self insured plan that allows the PBM
to be carved out.
• We work with 80 participants up to tens of
hundreds of thousands of participants
• Focus on Companies that are struggling in
current economy
• Public Sectors are in dire need of cost
savings due to decreased tax dollars

4. PBM Opportunity
Integrity RX
• Inflation – Most plans Increasing by 10% or
more annually
• Specialty Drugs = 75% of plan costs
• Drug Companies are focusing on specialty
drugs which will drive cost higher
• One size fits all

5. PBM Opportunity
Integrity RX
• Custom built plans for each employer – no
two plans are identical
• Plans built for specific needs of group vs.
one size fits all
• Written guarantee of savings
• Transparent
• Only PBM that actively manages
prescriptions with licensed Pharmacist

6. PBM Process
• Have Initial conversation with
– Private: CFO, Risk Manager/Purchasing and/
or Human Resources
– Public: Most public groups have a Purchasing/
Risk Manger

7. PBM Process
Start by Asking Questions
• How do you run your benefits?
• Self funded or Fully Insured
• Who does your drug card?
• Mr/Mrs Employer have you ever thought of
building your own 100% customizable
plan?
• We are here to save you money

8. PBM Process
To review plan we need
• Historical Claims File – They have on file or current
PBM has the information
• This is their information and they are entitled to
having this sent to them
• Ten business days to put proposal together
• Proposal presented to decision makers
• Consultative approach focused on customization
and cost savings

9. PBM Process
• Larger Organizations will have
– Decision making board/group
– Consultants or Brokers
– RFP Process
Initial Presentation to get the interest and the
entitys review or renewal process
Bring in Integrity RX for presentations and RFPs

10. Case Study
• 3,230 Member Construction Company
• Previous PBM = WHI
• Key stats at inception:
– PMPM = $52.78
– Historical Annual Trend Increase Avg = 8.8%
– Generic Utilization = 58%
– Mail Order Penetration = 6%
• $2 million drug spend

11. PBM
Who, what , and when
• PBM are contractual agreements
• PBM renew usually toward end of year
• PBM can and do move during year or start
review process soon
• PBM marketplace is dominated by 2 major
players that have been setting the playing
field
• Integrity RX is game changer

12. PBM ?
• How are we positioned to handle the influx
of large plans with thousands of
employees?
• Who is the back office behind Integrity RX?
• What are the parts of PBM and their
relationships?