Presentation on theme: "A Prescription Drug Program Presentation February 2007 From Broadreach Medical Resources, Inc."— Presentation transcript:
A Prescription Drug Program Presentation February 2007 From Broadreach Medical Resources, Inc.
BMR Proprietary & Confidential – February 2007 2 Table of Contents I.Broadreach Medical Resources (BMR) II.Case Study - Summary of Program Costs III.Case Study - Profile
BMR Proprietary & Confidential – February 2007 3 I.Broadreach Medical Resources (BMR) A.BMR is a Prescription Drug Program Administrator 1.New Business Model 2.Different Business Practices 3.BMR Offers all traditional PBM services including 56,000 Pharmacies 4.BMR offers more than Transparency 5.BMR Saves 20% to 30% of Program Cost.
BMR Proprietary & Confidential – February 2007 4 B.BMR Services your Drug Program through its Evidence Based Healthcare Program: 1.Initial Comprehensive Pharmacy Claim Audit and Plan Review (validates savings at no charge) 2.Ongoing Database Management -Risk Management -Clinical Outcomes 3.Periodic Drug Program Evaluations using Proprietary Analytical Software (Repricing, Therapeutic Category Analysis, Cumulative Claims, Risk Stratification) 4.Underwriting Services 5.Comprehensive Clinical Management Services 6.Program Cost Guarantee I.Broadreach Medical Resources (BMR)
BMR Proprietary & Confidential – February 2007 5 I.Broadreach Medical Resources (BMR) C.BMR Offers Sound Administrative Solutions to Lower and Control Drug Costs 1.BMRs Transparency is Absolute. SM a.BMRs Administrative Fee is its only source of revenue. There are no hidden revenue sources, margins or spread pricing. b.BMR practices Full Disclosure of all Business Practices, Contracts and Pricing. c.With BMR, there is no Vertical Integration of Delivery Systems (Mail and Specialty Pharmacy with Private Label Programs – Repackaging) that may cause conflicts of interest.
BMR Proprietary & Confidential – February 2007 6 2. BMR Offers Alternative Delivery Systems a. Mail Order Pharmacies who have agreed to BMR contract and audit terms (BMRs MAC, no repackaging, no drug manufacturer marketing programs, and no drug switch programs). b. Injectable (Specialty Pharmacy) Program on a cost of medication plus fixed dispensing fee basis. c. Carve-Out Diabetic Supply Program. d. Rebate Contracting through a new Class of Trade. e. New Product for Non-Profits. I.Broadreach Medical Resources (BMR)
BMR Proprietary & Confidential – February 2007 7 I.Broadreach Medical Resources (BMR) 3.Product Selection Programs a.Value Based or Economic Formulary – based on clinical equivalency and cost effectiveness (Dispensing or Prescribing). b.Aggressive Maximum Allowable Cost Program for Generics (priced below the MAC for Centers for Medicare and Medicaid Services). c.Mandatory Generic Program. d.Maintenance Drug List. e.Complete monitoring of drugs coming off Patent and Phase 3 clinical trial medications. f.Voluntary – Incentive Based Options.
BMR Proprietary & Confidential – February 2007 8 I.Broadreach Medical Resources (BMR) 4.Clinical Management Programs – Appropriate therapies based on patient disease as well as programs that manage costs by therapeutic categories. a.Step Therapy 1)Ulcer 2)Cholesterol 3)Non-sedating Antihistamines 4)Anti-Depressants 5)Nasal Decongestants 6)Dermatologicals 7)Arthritis 8)Antidiabetics 9)Antihypertensives b.Dose Optimization (Lipitor 10mg vs. Lipitor 20mg) c.Quantity Limitations – used on an AS NEEDED BASIS; i.e., Celebrex 2 per day; Enbrel 50mg 4 injections per 28 days. d.Prior Authorizations – Human Growth Hormones e.Patient Risk Stratification f.Physician Profiling (Gatekeeper) g.Integration with Medical Program to identify catastrophic cases with the capability of monitoring (or providing) of disease management program. 5.School Board Product
BMR Proprietary & Confidential – February 2007 9 II.Case Study - Summary of Program Costs BMR received claim history from the current vendor for the period January 2005 through December 2005. BMR repriced each prescription claim as if it were a BMR program. The following table summarizes BMR Initial Projections and actual client results. Paid Cost PaidPer Rx*per Member 2005 Actual$17,836,842$57.04$1,440 2005 Trended to 2006 Benchmark$20,435,665$62.34$1,650 BMR Target$18,632,573$57.83$1,505 BMR 2006 Actual$16,421,676$50.09$1,334 Difference BMR to 2005 Actual($1,415,167)($6.95)$106 Difference BMR to 2006 Benchmark($4,013,990)($12.25)$316 Plan Components Formulary Physician Education Generics with DAW Maintenance Drug List Step Therapy Injectables Covered in Medical or under arrangements with other Dose Optimization than copay with prior authorization including education & clinical Quantity Limitations evaluation * Includes Administrative Fee and Rebates.
BMR Proprietary & Confidential – February 2007 10 Member Copay Savings Formulary Compliance and No Zero Billed Rxs Total SpendPer RxPer Member (4) 2005 PSI Member Copayments (1) $3,788,770$12.12$307.11 2006 BMR Actual$2,498,428$8.60$202.52 Savings (2)$1,290,762$3.52$104.58 (1)Actual 2005 PSI Experience (2)Actual 2006 BMR Experience
BMR Proprietary & Confidential – February 2007 11 III.Case Study - Profile A.BMR improved pricing by 6.4%. B..7% (156 of 21,567 users exceed $10,000 per year). C.This group constitutes 12% of program cost. D.The 5 most costly TCAs of medication use were: 1.Ulcer Drugs9.25% 2.Antihistamines1.97% 3.Analgesics – Anti-Inflammatory3.97% 4.Antidepressants5.17% 5.Analgesics - Opioid2.62% E.Ingredient Cost Analysis CVBMR Savings% Savings $81.37$59.56 $21.81 26.8% F.Stratification of Risk by Disease State DiseasePatients over $10,000Patients under $10,000 HIV/AIDS/Hep C13572 Hypertension 784,582 Diabetes452,019 Cancer24241
BMR Proprietary & Confidential – February 2007 12 Exhibit 1A Summary of Claims - Benchmark
BMR Proprietary & Confidential – February 2007 13 Exhibit 1B Summary of Claims – BMR Current
BMR Proprietary & Confidential – February 2007 18 Risk Stratification of Diabetics BMR Analytical Software classifies patients – By dollars – By disease state Client Illustrations – Cumulative Claims – Patient Profiles – Classification by Severity
BMR Proprietary & Confidential – February 2007 19 How Diabetic Medications Relate to Rx and Health Plan Costs Number of Diabetics in a health plan population is approximately 7%. BMR has found that Diabetics constitutes approximately 26.9%* of Rx program cost across an integrated active and retiree population. Diabetic and related medication costs, therefore, comprise approximately 6% of health plan costs. * Due to diabetes-related complications and co-morbidities Source: BMR Plan Experience
BMR Proprietary & Confidential – February 2007 20 What will be Coming
BMR Proprietary & Confidential – February 2007 21 Disease States in Individuals > $10,000
BMR Proprietary & Confidential – February 2007 22 Disease States in Individuals >$10,000
BMR Proprietary & Confidential – February 2007 23 Cost Per Diabetic User Progression