SKYGEN USA Launches Hylis Pharmacy Solutions
The new company will use its deep understanding of the inner workings of prescription drug programs, in conjunction with the world-class analytics capabilities of sister company Wonderbox Technologies' Enterprise System, to act as a client advocate. It will provide large self-insured plan sponsors with unprecedented transparency into the actual cost of delivering pharmacy benefits to their members to help reduce and control prescription drug program costs. The company will use its technology to perform a retrospective analysis on an organization's actual claims, then accurately document and report the expected savings.
"While the industry is focused on savings, the complexity of the transactions and the lack of transparency make it difficult for plan sponsors to determine whether those savings are being maximized," said
Preliminary estimates from IMS Health's
Pharmacy Benefit Managers (PBMs) were originally created to improve the administration of prescription drug programs by adjudicating pharmacy network claims online. Through their aggregated purchasing power, PBMs have also gained the ability to negotiate with pharmacies to achieve better pricing. In addition, management techniques such as encouraging the use of generics in place of brand name pharmaceuticals and managing drug formularies also help reduce costs. PBMs are normally paid a fee for these services.
In recent years, however, the industry business model may have taken advantage of the lack of transparency in its financial transactions to gain additional revenue. For example, spread pricing occurs when PBMs pay pharmacies one cost to dispense the prescriptions, and then bill plan sponsors at a margin greater than this rate. The resulting additional profit-taking leads to increased costs for the self-insured plan sponsors or health plans. Borca says there are seven to eight of these types of practices PBMs may use to inflate the average wholesale price. They can be difficult to expose because of the complexity of the industry.
"Our experts know the PBM industry well, so they understand where to look," Borca said. "Then our technology takes over. By automating the discovery process, we look for patterns across large amounts of data and make recommendations that will have a significant impact in reducing our clients' costs."
Hylis Pharmacy Solutions is so confident in its ability to uncover issues and help organizations that it will perform an analysis of a plan sponsor's prescription drug spend free of charge. If it is determined that changes need to be made, Hylis Pharmacy Solutions' revenue comes in the form of a percentage of the realized savings, eliminating any direct cost to the plan. The company then continues to validate the data on an ongoing basis to ensure that appropriate costs are maintained.
Many plan sponsors are often disappointed to learn how much additional they have been paying over the years and are grateful that Hylis Pharmacy Solutions is finally bringing closure to this problem.
"This is an issue that affects a large percentage of the group insurance market, yet one that has been difficult to pin down," Borca said. "Our goal in launching Hylis Pharmacy Solutions is to steer pricing downward toward the best interest of the member and the plan sponsor over anyone else."
About
About Hylis Pharmacy Solutions
Hylis Pharmacy Solutions (HPS) is a leading-edge data analytics company focused on bringing a new wave of technology-driven intelligence to plan sponsors that enables them to implement savings initiatives that deliver the most cost effective and clinically appropriate prescription drug programs to their members. HPS is part of a growing family of companies specializing in one of the world's most innovative benefit management solutions that reduce the cost of healthcare benefit delivery. The organization's sister companies include Wonderbox Technologies, Scion Dental,
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SOURCE Hylis Pharmacy Solutions
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