Pharmacy benefits data represents your unique footprint. Think of it as a fingerprint. It is a unique signature for who you are as an employer group, what your membership is like, what types of medications come in and out. It tells you what type of disease states are impacting the plan. So you’ll know – do I have a healthy plan or do I have an unhealthy plan? If I have a healthy plan, is the access too much or is it too little? What can I do to make decisions that will be beneficial for my members but at the same time not cost a lot of money?
We want to spread out those dollars as much as possible so that we have an affordable benefit for everyone. Having the data in place enables you to see, how many members will be impacted if I did this? Or if I didn’t do this, how much can my costs potentially go up over time? The data-driven approach is the way to go, and it allows you to make decisions without any emotion in it. Using data enables you to be objective.
As a managed care pharmacist, that is the most valuable thing to me, so I know what I can do for the population as a whole. There may be options for individual members that the data will indicate, but when you’re looking at the whole population of your plan, it’s about the trends that are happening across the entire membership and being able to make decisions based off the entire membership.
This approach boils down to knowing who you are and what your data tells you. Your data will indicate where you need to be.