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Integrity Rx 6 5

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Cutting edge Pharmacy Benefit Management

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Integrity Rx 6 5

  1. 1. Integrity RX PBM Training 6-5-2012
  2. 2. Today’s Agenda• PBM Opportunity• PBM – Process and Protocol• PBM – Who, what, How and When• Questions and Answers
  3. 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. 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. 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. 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. 7. PBM ProcessStart 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. 8. PBM ProcessTo 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. 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. 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. 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. 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?

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