In today’s environment of rapidly increasing pharmacy costs and growing demands for improved care, payers are facing ever-increasing pressure to stay financially competitive while delivering quality care for their members. AArete offers a suite of clinically-derived pharmacy consulting solutions that are driven by data and proven in the field to help you identify problem areas and implement long-lasting results. By analyzing multiple disparate sources of data, AArete offers unparalleled solutions to address your biggest pharmacy concerns.
Drawing on our unique clinical and analytical perspective, we compare your formulary management against local and national best-in-class benchmarks, using various methods to optimize the utilization of drugs on your formulary. This includes the review of prior authorization policies, drug tier review, step therapy and non-formulary in order to identify opportunities to implement greater controls — without disrupting member care.
AArete carefully reviews all of your drug offerings to:
Determine the fully-loaded cost to your plan of every drug. We use deep industry knowledge to make informed decisions on the clinical value, importance and cost of each drug to your plan.
Recommend the use of drugs that are the most medically effective with the lowest financial costs. Through data analysis, we are able to determine which drugs have the highest cost but the lowest clinical effectiveness.
Help you make both the best clinical and financial decisions. We draw on our financial and data analysis expertise to give you the most cost-effective means of providing effective drugs for members.
The pharmacy landscape is changing constantly with new generic drugs, fluctuations in drug pricing and new legislation. AArete looks at all the drugs accessible to your members and determines their pricing for the current year. We then refresh our analysis, year over year, taking into account any recent changes the pharmacy industry has undergone.
Pharmacy Benefits Manager (PBM) Contract Optimization
AArete helps you analyze, understand and compare your PBM contract against best-in-class market offerings to enable cost reduction and ensure compliance, making certain the terms have been executed correctly. Then, if necessary, we work to help you renegotiate the contract. If unnecessary, we give you the confidence and reassurance that your contract terms are being executed just as they should be.
AArete brings data analysis to your contract optimization, drawing on a number of different payers and providers across the nation to gain unique market intelligence, a clear perspective on the pharmacy industry today and its coming trends. We then couple these market insights with actual claims data to measure the financial impact of any contract changes. By combining actual claims data and contractual metrics, we’re able to view your PBM contract holistically, helping you find a variety of opportunities for reducing your costs and improving your operations.
Quantity Limit Optimization
Despite existing PBM controls and clinically recommended dosage limits that state how much of a drug a patient should take, our analysis will occasionally identify gaps in these thresholds. By comparing claims data against clinical dosage standards, we are able to identify over-prescription gaps and measure the actual cost overrun caused by these gaps. By implementing corrective action, we are able to reduce costs, increase drug control and improve member well-being.
Our combination of data analytics capabilities and clinical expertise gives us the ability to quickly and efficiently analyze several hundred drugs and contrast their recommended dosage limits with the medical history of all members.
Medical Pharmacy Optimization
Until recently, the medical pharmacy sector (which includes drugs administered in physicians’ offices and hospitals), was a small, almost-hidden corner of the overall pharmacy industry. Now, it has become a blossoming giant of complex, expensive drugs accounting for nearly half of all pharmacy spend. This sector’s rapid growth has caught many payers unprepared, and without appropriate cost controls.
AArete can help you better control this spend by leveraging our experience with pharmacists, CEOs of leading payers/providers and other industry experts. As a result, we’ve combined best-in-class tools with our unparalleled ability to analyze data in order to develop results-driven solutions that will work for you.
By bridging the gap between medical and pharmacy datasets, we’re able to:
– Gain the complete picture of the members medical history
– Identify instances of unwarranted prescriptions
– Find cost optimization opportunities with drugs that can be billed either through pharmacy or medical claims
Specialty Pharmacy Solutions
In addition to our work on medical pharmacy solutions, we can help you optimize your specialty pharmacy programs — programs which deal with drugs that require individual handling or maintenance, such as refrigeration or particular compounding by the pharmacist at a high expense.
Similar to the way we approach other pharmacy solutions, we rely on our long-standing clinical expertise, deep industry insights and ability to analyze/leverage large, disparate datasets in order to achieve savings and deliver results. As the cost of these drugs continue to skyrocket (reaching as much as $2 million per use in some cases), and by leveraging our experience with the solutions we’ve delivered to dozens of payers, we’re able to advise on optimal strategies to help you manage these drugs.
Pharmacy Benefit Manager Audits
At AArete, we help payers in the pharmacy industry meet their Centers for Medicare and Medicaid Services (CMS) obligation to execute effective compliance programs. Through our work, we’ve developed expertise conducting annual PBM audits (claims/pricing, formulary rebates and performance guarantees) to ensure contract compliance for every client.
Drawing on our extensive experience and clinical knowledge, we work with you to complete detailed, complex audits across the supply chain to help uncover the millions of dollars that could be at stake each year. Even if it’s only a small percentage of your spend, successful audits can easily yield between $2 to $10 million in savings.
Our Pharma Experts
Maulik is based out of AArete’s London office and leads AArete’s Digital and Data Services as well as International Business. Overall, Maulik comes with over 15 years of experience in Operational and Management Consulting across multiple industries working with Ernst & Young, Protiviti Consulting and Huron Consulting. He has experience leading large consulting engagements for clients delivering measurable bottom line improvement, digitally enabled process efficiencies and organizational change, through fact-based data intensive analysis combined with domain expertise. Maulik holds a Master of Business Administration degree from S.P. Jain Institute of Management and Research (SPJIMR), a Bachelor in Accounting and Finance from Mumbai University, and is a Certified Information Systems Auditor and a Six Sigma Green Belt. He is a published author and quoted industry expert in Managed Healthcare Executive, Chain Drug Review, ThinkAdvisor, American Pharmacists Association and Chain Store Age.
Kevin specializes in data analytics and mining, business process improvement, strategic sourcing solutions and leading strategic profitability improvement initiatives. His broad range of healthcare experience, including both the Provider and Payer side, makes him an integral member of AArete’s analytics team. Kevin has worked with large managed care organizations (MCOs) and hospitals to deliver cost savings results and operational and strategic business insight. Kevin holds a Bachelor of Science degree in Business from the Kelley School of Business at Indiana University and was recognized as a Consulting Magazine “2019 Rising Stars of the Profession – Consulting’s 35 under the age of 35” award winner.
Brian Moy advises health plans, Managed Care Organizations (MCOs) and other health service organizations in driving implementable solutions to solve complex issues and delivering measurable results that positively impact the bottom line. He provides expertise in data analytics and deep industry knowledge and leads AArete’s Health: Pharma and Payment Intelligence (TM) service lines. He has led numerous engagements achieving results through unit strategic profitability improvement initiatives, optimization of utilization or demand management, quality enhancement and promotion of positive outcomes, improving revenue/Payment Intelligence™ and enhancing reporting and compliance capabilities. Brian holds a Masters of Science degree in Communications from Northwestern University, a Bachelor of Arts degree in Communication Studies from North Park University, an Associate of the Arts degree in Communication Studies, is Certified in Conflict Transformation from North Park University and is a published author in Chain Drug Review.
Dane has nearly 10 years of experience across a variety of industries including healthcare pharmaceuticals, healthcare payers, education and diversified industrial. He specializes in using data analytics to identify operational efficiencies leading to strategic profitability improvement. He has applied these skills as a lead in AArete’s pharmacy practice, assisting payers in designing their pharmacy programs, optimizing existing controls and negotiating with 3rd party vendors. In his career, he has negotiated $100M+ in vendor cost reduction and delivered an additional $100M in operational efficiency improvements. Dane holds a Bachelors of Science degree in Mechanical Engineering from the University of Illinois at Urbana Champaign and is a published author in Chain Drug Review.
Mike Kim is Vice President Data & Analytics and Head of AArete’s Center of Data Excellence (CODE). Mike’s over 15 years of analytics experience includes technical delivery of machine learning/predictive models, implementation of advanced database designs, custom application development, and thought leadership for various analytic strategies. Representing healthcare, entertainment, professional sports, and numerous other industries, Mike co-leads AArete’s Digital & Data Services solutions and international expansion efforts. He holds a PhD in Health Policy and Management from Johns Hopkins University, a Masters of Public Health degree and a Bachelor of Arts degree in Biology from Brown University. Mike is a published author in Chain Drug Review, American Pharmacists Association, Mass Market Retailers, Retail TouchPoints, Advertising Age, Retail IT Insights, Managed Healthcare Executive, Property Casualty 360 and Financial Executives.