ArxAnalysis is an innovative program administered by Arxcel’s expert prescription benefit management consultants that provides a detailed analysis of the prescription plan’s financial operations. The audit identifies inconsistencies, discrepancies and errors so employers have the data necessary to design the prescription benefit plan that works best for their unique member needs.

With ArxAnalysis, Arxcel analyzes claims data, facilitates resolution of outstanding account issues and provides clients with up-to-date information on recent events and trends in the pharmaceutical industry. Further, Arxcel can provide ongoing evaluation and recommendations for plan design changes.

The use of audits to evaluate vendor performance is an established practice in most industries. However, evaluating a PBM’s financial performance has not been a common practice of plan sponsors. Unlike other PBM audits, which review a random sample of a plan’s claims, ArxAnalysis reviews every claim for accuracy. 

Now Arxcel can compare claims history and payments against contracted terms and target opportunities for additional savings by identifying overcharges . When the retrospective review of claims is completed, Arxcel provides a summary report to the sponsor of the identified savings in their benefit program. Contact us to learn more.

n the heels of increased attention and proposed legislation regulating how Prescription Benefit Managers charge

their clients, PBMs are facing additional scrutiny from oversight committees and corporations pressing for more transparency to help them navigate complex employee drug plans.

A coalition of 56 large employers including Caterpillar, Inc., International Business Machines Corp., Starbucks and Ford Motor Corp., has joined together to form a drug purchasing coalition, the Health Policy Association, in a quest to make PBMs’ financial practices more transparent. The association argues that the financial arrangements between PBMs and drug makers are too complex and tend to align the PBMs’ interests with those of the drug company rather than the plan sponsors’.

The coalition has succeeded in obtaining agreements with several PBMs — including two of the largest, Medco Health Services Inc. and Caremark Rx Inc. — that allow for disclosure of purchasing costs and manufacturer rebates.

Efforts by the coalition to certify PBMs under more stringent requirements, however, did not prove fruitful. Opponents argued that the competition among PBMs
already ensures transparency, and forcing PBMs to further disclose “proprietary” information will only end up hurting consumers by increasing plan costs.

Transparency is more than a matter of how a PBM processes a claim or recoups a rebate from a drug manufacturer. PBMs have various other revenue streams, including the “spread” between what the manufacturer charges and the PBM bills the employer, the formulary preference model and various administrative and plan fees.

Regardless, there is little evidence proving a correlation between fuller disclosure and lower drug spend. Chris Robbins, Arxcel CEO, points out: “Transparency is a great goal, but by itself it doesn’t get to the core of the issue, which is: Is the PBM administering the plan in a manner that is best for the plan’s sponsors and members?”

Whether through joining a coalition of sponsors or seeking better information directly from their PBM, employers need to be educated consumers of their
prescription management contracts to ensure that members are receiving the benefits that allow them to be healthy, productive workers.

Free drug trials, coupons and rebates for brandname drugs have consumer groups pressuring the Food and Drug Administration to ban such promotions.

An alliance of more than 20 groups argues the trials may attract consumers to risky and unnecessary medications with no long-term cost benefits. They contend that a coupon for a brandname drug may lead a person away from a less expensive drug that can be just as effective and once the patient is using the brandname prescription they’re unlikely to switch to a generic equivalent. Some critics have said that these promotions fail to include sufficient information such as drug side effects or risks. Drug makers counter by saying the promotions reduce costs for patients and allow them to try new medications.