Magazine article Drug Topics

PBM Targets Mid-Size Firms for Value Pricing

Magazine article Drug Topics

PBM Targets Mid-Size Firms for Value Pricing

Article excerpt

PharmaCare Inc., a pharmacy benefits management subsidiary of CVS Corp., thinks it's found a solution for mid-size companies looking to reduce health-care costs. With its Value Pricing Program (VPP), the Lincoln, R.I., company hopes to increase generic prescriptions to 40% or more of the total Rxs that plan members receive.

The keystone of VPP is the Clinical Information Management System (CIMS), which has been in use since mid-1994 by larger employer groups and managed care facilities. PharmaCare v.p. for national sales Joseph A. Botta said VPP is all about making cost-saving technology available to smaller companies.

"Typically, the client that buys CIMS is either a very large managed care organization or an employer group that has 10,000 to 20,000 employees. There's not that level of sophistication in pharmacy benefit management in a company that has 1,000 to 3,000 employees," Botta said.

It's those mid-size companies that PharmaCare is targeting with VPP. Since the program began in August, Botta said that more than half a dozen clients have signed up and that feedback has been overwhelmingly positive. His firm anticipates that VPP will raise the percentage of generics prescribed from roughly 25% to "at least 40% or more" of all member prescriptions.

CIMS, proprietary technology developed by PharmaCare, is a mainframe system that tracks and analyzes a patient's prescription history, including compliance. With VPP, a new application for CIMS, the prescription enters into the data bank at point of sale. CIMS runs the prescription against the patient's history and analyzes whether a generic alternative would be appropriate. According to Botta, the system takes into account factors such as gender and age, and also whether a patient has already tried and been dissatisfied with the generic alternative available for treatment.

If CIMS decides an intervention is preferable, it contacts the physician with the suggested generic as well as data that would support substitution as an appropriate choice. If the physician agrees, he or she sends back a form, which CIMS uses to generate a letter to the pharmacy and the patient, informing them of the change. The substitution actually takes effect when the original prescription is renewed. …

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