This report allows for displaying high level pharmacy data by Provider Specialty, Disease Category, Drug Class and Drug. The header provides the reference points needed to understand the pharmacy data and includes the arrows for quick analysis of trends.
Target Audience for this Report
Chief Medical Officer, Compliance & Regulatory Department, Finance Department and CFO, Leadership Team, Medical management/Care Management Department, Pharmacy & Therapeutics Committee, Physician Relations, Quality Management, and Utilization Management.
Business Impacts of this Report
Merging pharmacy and medical claims data can generate a complete picture of health care usage and spending. This results in forecasting costs, rates, and premiums for the health plan. Pharmacy analytics drills down to the specific cost drivers identifying areas with potential for improvement which can make a difference in the cost of medications as well as the health outcomes for members. Provider education and monitoring is enhanced by the pharmacy data and can support initiatives to help providers increase generic use, increase compliance with the formulary, and assist their patients in compliance with medication regimens. The data assists the health plan in evaluating the effectiveness of prior authorization or quantity limits placed on medications. Evaluating the effect of various formulary restrictions on cost savings in collaboration with the PBM is facilitated by this data and provide member level detail as well as aggregate tracking and trending.
Detail and Definitions
Navigation options are limited within this visualization. Note that the header information, and the table information (below the KPI trending charts) are based on detailed reporting period. Note that the header information is active, and will change when selections are made/filters are applied. A unique pharmacy script is a calculated field that consist of ‘MemberNumber’, ‘PrescriberProviderID’, ‘PrescriptionFillDate’, and ‘NationalDrugCode’.
This visualization can be configured for either Total PMPM, Total Paid, or Paid/Script, based off of the selection made in the “KPI Measure” selection box in the header. The selected value corresponds to the column shown within each table; “Provider Specialty Ranking”, “Ranking by Disease”, “Ranking by Drug Class”, and “Ranking by Drug”.
- KPI Measure selection (Total PMPM, Total Paid, Paid/Script)
- Total Paid
- Period RX PMPM
- Generic Use Rate
- Formulary use Rate
- Avg Membership
Ranking by Provider Specialty
Ranking by Disease
- Disease Class
Ranking by Drug Class
- Drug Class
Ranking by Drug
- Drug Name
Accessed by clicking on the graph icon in the upper right of the report.
Period by Period Trends (Graph)
Displays the trends of Rates per 1000, Scripts/Member, Non-Formulary, Formulary and Generic Use by the selected period; year, quarter, or month. The graph changes with applied filters found in the header. This snapshot of these indicators provides significant information regarding Pharmacy costs and usage and the graphical display provides quick reference points to guide a deeper analysis.
Period Over Period Trends (Graph)
Displays the selected time period trends in percentages over the previous period. The graph changes with the applied filters found in the header. By describing period over period in this manner the user can easily determine progress or decline in the indicators.