Conduct a Claims Data “X-Ray”

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

Our firm’s claims data “X-Rays” typically identify millions of dollars of savings for Plans via the following in-depth analyses:

Evaluation of Average Costs & Likely Savings By Changing PBM Contract Terms

  • How much your PBM is actually charging your Plan for (i) Brand Drugs, and (ii) Generic Drugs, 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

Evaluation of Every Drug’s Costs & Likely Savings By Implementing Certain Changes

  • 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 – and in the aggregate – if you make changes our firm recommends

Evaluation of Quantity Limits (or lack thereof) & Likely Savings By Implementing Changes

  • Which drugs your PBM is dispensing without appropriate quantity limits
  • How much your Plan will save by implementing appropriate quantity limits

Evaluation of Different Pharmacy Costs & Likely Savings From Changing Your Network

  • The average drug discount that each pharmacy is providing to your Plan for Brand Drugs and for Generic Drugs
  • How much your Plan will save if your Plan creates a Limited Pharmacy Network and excludes the highest-cost pharmacy chain and possibly other high-cost pharmacies

Evaluation of Potential Plan Savings From Implementing A Specialty Drug Coupon Program

  • The savings your Plan can achieve – in addition to savings that your Plan beneficiaries can achieve – if your Plan implements a Specialty Drug Coupon Program to take advantage of available Specialty Drug coupons


Provide our firm with a few months of claims data. We’ll perform a claims data X-Ray and tell you exactly what you need to know to significantly decrease your Plan’s prescription coverage costs, probably by millions of dollars.