Pharmacy Benefit Management Institute Recognizes Innovation in Drug Benefit Industry

Business Wire, Feb 22, 2007

SCOTTSDALE, Ariz. -- The Pharmacy Benefit Management Institute (PBMI) has awarded its 2007 Rx Benefit Innovation Awards to the Department of Defense (DoD) TRICARE Management Activity, PharmaCare and the Polk County Board of County Commissioners, and SXC Health Solutions, Inc., for improving the delivery of benefits in a fiscally responsible way.

The DoD TRICARE Management Activity is being recognized for an online, real-time coordination of benefits program (COB) that significantly reduces the hassle factor for TRICARE beneficiaries who have drug benefit coverage from multiple sources, while also generating cost savings for the DoD Pharmacy Program. PharmaCare and the Polk County Board of County Commissioners in Bartow, Fla., are being recognized jointly for an employer-based, pharmacist-coordinated disease management program that measurably improves the health status of diabetic and hypertensive employees and retirees. SXC Health Solutions, Inc., is being recognized for a technology solution that enables the sponsors of drug benefit plans to engage their beneficiaries in understanding drug costs and choosing low-cost alternatives when medically appropriate.

"The 2007 award recipients all have forward-thinking solutions that improve the value of the drug benefit by empowering consumers," says Dana H. Felthouse, MBA, president of PBMI. "They also showcase the value of genuine collaboration among stakeholders in the drug benefit arena."

The DoD's electronic, point-of-purchase COB program minimizes the need for millions of TRICARE beneficiaries to incur reimbursable out-of-pocket expense and then file paper claims for reimbursement. In the eight months following the COB launch, 350,000 TRICARE beneficiaries used the service. Nearly 95% were able to obtain their prescriptions with no out-of-pocket expense. The program is generating an estimated savings of $1 million annually in reduced TRICARE claims processing fees.

In the Pharmacare/Polk County collaboration, PharmaCare placed a full-time clinical pharmacist onsite in Polk County's employee health clinic to help employees, dependents and retirees manage diabetes and hypertension. More than 700 diabetic and hypertensive patients are enrolled in the program, which has resulted in significant average per-patient reductions in HgbA1c and blood pressure values.

SXC's RxPORTAL[TM] is a consumer-friendly, online decision support tool that enables beneficiaries to run real-time trial adjudications to compare the cost impact of prescription drug alternatives, based on their own benefit design. Beneficiaries also can access quality and safety information regarding their prescription alternatives and identify the nearest pharmacy offering the best price. Analysis of trial adjudications submitted through RxPORTAL indicated that nearly 40 percent of consumers who used the tool to investigate more cost-effective drug alternatives made the decision to use a lower-cost product. These consumers realized an average per-claim savings of $41.80.

PBMI Educates Industry

The fifth annual Rx Benefit Innovation Awards were presented today at PBMI's 12th annual Prescription Drug Utilization Management Conference at the Pointe Hilton Tapatio Cliffs Resort in Phoenix. Past winners include AmeriHealth Mercy/Perform Rx, Cingular Wireless, Cypress Care, Catalyst Rx, ePocrates, Express Scripts, HR Policy Association Pharmaceutical Purchasing Coalition, Medco Health Solutions, Memorial Health System, Prescription Solutions, and University of Michigan.

More than 350 industry professionals involved in the design and administration of drug benefit programs attend the nation's premier meeting dedicated to drug benefit management. PBMI provides research, continuing education, publications and Web resources to help health care purchasers work effectively with pharmacy benefit managers and other industry professionals to improve pharmacy benefit programs and control costs. Read case studies on award winners at www.pbmi.com.