Using Provider Scorecards to Improve Hospital Pharmacy Benefits Management

Do you receive your pharmacy data and understand its value? Have you wondered what this means to the plan? At RxBenefits, we work with our hospital clients with in-house pharmacies to help understand the data and help drive employees back to the in-house pharmacies when most cost-effective for the plan.

Some important factors to consider when bringing high-cost specialty claims in-house include patient care and ease of access. From a patient’s perspective, typically these medications have to go through a mail channel, where the member has to wait several days to obtain their specialty medication. Now, having those claims in-house, that provides someone there they can connect with and help them understand their medications. We work with the in-house pharmacies on understanding what medications they have access to and what avenue would provide the lowest net cost channel to the health plan.

In addition, with access to the plan’s pharmacy data, we’re able to provide back information on provider scorecards. We’re able to help you understand how the providers are prescribing. Are they prescribing mostly brand medications, or are they prescribing generics? We’re there to help communicate to your providers on the formulary, utilization management, and education surrounding generic medications.

Do you know what high-cost prescription drugs are being dispensed outside of the in-house pharmacy? We consider the hospital’s pharmacy team to be our partners and work with them to provide more information as to what these drugs are. We want to find out, do they have access to these medications? Are they limited distribution or stat medications? If the in-house pharmacy does have access, we help to educate the members on why they should be filling these at the in-house pharmacy.

Check out our free webinar, Top Strategies to Overcome the Toughest Hospital Pharmacy Benefits Challenges, to learn more about how to align the pharmacy benefits management strategy with the hospital’s owned resources.


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