Thoroughly Analyze Your Claims Data

Your Plan’s claims data provides you with a window to learn (i) why your Plan’s costs are so high; (ii) what your Plan can do to lower its costs; and (iii) how much your Plan can save if it takes certain actions.

Our firm performs in-depth claims data analyses that can provide the following information to your Plan:

  • How much your PBM is actually charging your Plan for (i) Brand Drugs, and (ii) Generic Drugs, when each are dispensed at (a) retail, (b) retail 90, (c) mail, and (d) specialty drug pharmacies
  • How much your Plan will save, if your Plan obtains a better PBM contract that provides competitive prices for Brand Drugs and Generics Drugs at each of the above pharmacy venues
  • Which drugs are costing your Plan the most money – and which the least – based on a “High-to-Low Cost Analysis” of every drug used by your Plan beneficiaries
  • Which drugs you should stop covering – or disfavor in Prior Authorization or Step Therapy Programs – and how much your Plan will save for each such drug if you do so
  • Which drugs your PBM is dispensing without appropriate quantity limits
  • How much your Plan will save by implementing appropriate quantity limits
  • The average discount that your Plan is getting for Brand Drugs and for Generic Drugs at each pharmacy
  • How much your Plan will save if your Plan creates a Limited Pharmacy Network and excludes your highest-cost pharmacy chain and other high-cost pharmacies
  • The savings your Plan can generate if it implements a Specialty Drug Coupon Program that will take advantage of available coupons to reduce your Plan’s costs


Provide Pharmacy Benefit Consultants with several months of your claims data. We’ll perform a claims data X-Ray and tell you everything you need to know to significantly decrease your Plan’s prescription coverage costs.