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 Home > FAQs   
How can RxAmerica save money in healthcare costs?
Question - How can RxAmerica save money in healthcare costs? Answer - The average employeer is experiencing a 15%-20% drug inflation per year, with most major health plans experiencing more rapid acceleration. And, in the majority of cases, we believe that this cost spiral represented a poor value to payers and patients alike. In contrast and over the same time period, RxAmerica has documented experience holding drug cost escalation to less than 6% without a concomitant rise in the consumption of outpatient or inpatient medical services. RxAmerica is so confident of its ability to limit escalating pharmaceutical costs it is willing to establish substantive performance guarantees towards a targeted rate. Proven cost savings are achieved through a combination of services offered by RxAmerica: First, we provide a RxAmerica account service team. The team is headed by an experienced clinician expert in quantitative analysis and with the communication skills and business acumen necessary to not only identify an area for improvement, but also to build provider and client support, successfully implement and operate the initiative, and accurately quantify returns. Second, the RxAmerica account service team is empowered to find the right solution for the client. Because a pharmaceutical manufacturer does not own RxAmerica, it is free to fully manage the formulary. RxAmerica has saved a client over 15% of it pharmaceutical costs simply by managing the use of only 5 medication types to their appropriate niches and/or doses. Most of our competitors did not, and could not, do this. Our service team is equipped with the appropriate tools. Third, expert system logic in our claims processor that, based upon a patient’s medical history, can detect whether or not a prior-authorization is required based upon a patient’s individual medical history. For example, a good deal of medical literature supports that COX-2 inhibitors, the most “successful” introduction by the pharmaceutical industry on a dollar basis ever, are not economically or clinically justified for patients without a recent history of ulcers. Regardless of a physician completing any paper work, RxAmerica’s claims processing system can detect if a patient has such a history. Fourth, RxAmerica links Plan member’s pharmaceutical consumption with its inpatient and outpatient utilization and demographic background contained in a standard membership file. Fifth, RxAmerica has abundant and readily available corporate resources. Not only do we expect, but we require our Plan account service team to rely on RxAmerica’s corporate assets.
Question - How is RxAmerica different from other Pharmacy Benefit Management companies? Answer - RxAmerica differentiates itself from our competitors through responsive account management, demonstrated clinical expertise, and independence from pharmaceutical companies. The following programs and features differentiate RxAmerica from our competitors: Regional Offices - RxAmerica has full-time associates based throughout the West. Our staff of trained managed care professionals will provide the plan with superior customer service and supply an immediate response to all of the plan’s needs. On-Site Reporting - Several options are available for reporting, manipulation, and sorting of the data. Speed of implementation of plan changes - RxAmerica has the capability to rapidly implement plan changes, usually within one working day of request. Database management and data extraction - RxAmerica’s relational database system provides the ability to extract data, analyze and provide raw data to the plan as needed. Focus on lowest PMPM - RxAmerica’s programs and features take into account the lowest overall cost. We believe that the most cost-effective medication is the item that is clinically superior and is available at the lowest cost, not the highest rebate. We believe that emphasizing overall cost, rather than rebate generation, provides the best value to our clients. Financial Arrangements - Many options are available including shared risk, fee for service, differential, and incentive pricing. Pharmacist Care - Throughout RxAmerica, registered pharmacists hold key positions in the company. Pharmacists at the mail service facility will call the physician to clarify or correct a prescription instead of just mailing the unfilled prescription back to the patient. In addition, RxAmerica offers the following important distinctions in the following areas: Disease Management - RxAmerica’s Partners In Health program offers CareSense disease management programs for Asthma, Diabetes, Hypertension and Congestive Heart Failure (CHF). Program evaluation indicates improved patient outcomes, reduced costs, and a significant Return On Investment. The Partners In Health program allows us to offer our customers resources and expertise not found with any one organization. Personnel Resources - RxAmerica has a full-time, Ph.D. Pharmacoeconomic Fellow, dedicated to providing leadership to our disease management and compliance initiatives. Flexibility - RxAmerica has the ability to customize our disease management initiatives, utilizing multiple strategic partners. From off-the-shelf programs to those specifically developed with the customer, we are capable and willing to put the plan’s needs first.
Question - How does technology enable RxAmerica to be a leader in the industry?
Answer
- We invest in the types of software and hardware that truly benefits our clients. RxAmerica’s decision support and reporting functions occur on a Sun Enterprise 4500 system. Use of this system provides maximum reporting flexibility and speed without impacting transaction based processing. RxAmerica’s decision support system provides 150 gigabytes of data file storage capacity with an additional 200 gigabytes for growth. RxAmerica has developed our claims processing software, remote-site applications, utilization reporting, and graphical interpretation systems internally. Development of our system (AmeRx) has been an ongoing process of continual improvement and increased functionality. AmeRx provides claims processing accuracy that exceeds 99.9 percent. Since all claims are processed on-line while the member is at the pharmacy, discrepancies are virtually non-existent. RxAmerica’s claims processing system performs over 35 edits at each exception of five exception levels. All claims entering RxAmerica’s on-line system, whether from participating community pharmacies, mail service, or subscriber claims, are adjudicated in an on-line, real-time environment. RxAmerica’s network pharmacy providers are required to submit claims electronically to our AmeRx claims processing system. Electronic submission allows a higher degree of plan management and the opportunity for better employee healthcare.
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