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PBM Analytics: Essential KPIs for CHROs

If you’re a big shot in HR, especially one looking to make a real difference in your company, this is for you. Let’s talk about something called pharmacy benefit management or PBM analytics. It’s all about making sure your team gets the medicine they need without breaking the bank. Sounds good, right? Here, we’re going to break down the must-know stuff (those fancy Key Performance Indicators or KPIs) that’ll help you rock your role and keep everyone healthy and happy.

Why PBM Analytics Matters

Pharmacy Benefit Management isn’t just about pills and prescriptions. It’s your secret weapon for keeping healthcare costs in check while making sure your crew gets the care they need. By diving into the data, you can spot ways to save money and boost health benefits.

The KPIs You Need to Know

  1. Cost Per Member Per Month (PMPM): Think of this as the average amount of money spent on meds for each person every month. Keeping an eye on this can help you figure out where your money’s going and how to spend it smarter. Goal < $100 PMPM.
  2. Generic Dispensing Rate (GDR): This one’s about choosing store-brand cereal instead of a fancy one. Generic meds are usually much cheaper than brand names, so a high GDR means you’re saving more dough. Goal > 90%. For every 1% you increase GDR, pharmacy costs decrease by as much as 5%! Increase GDR from 83% to 88% and your total pharmacy costs decrease by 25%, for example.
  3. Medication Adherence Rate: This is all about making sure folks are taking their meds as prescribed. When they do, they’re healthier, and you won’t have to spend extra on doctor visits or other treatments. Goal > 80% PDC.
  4. Specialty Drug Spend: Some meds are super expensive because they’re for rare or hard-to-treat conditions. Tracking this spending can help you find ways to manage costs better. Goal < 30% total drug spend.
  5. Therapeutic Optimization: This fancy term just means making sure everyone’s getting the best possible treatment without overspending. It’s like getting the best bang for your buck. Goal > 98% GSR.
  6. Plan Utilization: This is about seeing how everyone’s using their pharmacy benefits. Are they going for mail-order or picking up meds at the store? Knowing this can help you tweak the plan to make it better for everyone. Goal > 20% mail-order utilization measured by average days’ supply.

Making It All Work

Being a CHRO means you’ve got a vital role to play in making sure your team’s healthy and the company’s thriving. By focusing on these KPIs, you’ll be able to make smart moves that benefit everyone. And remember, you don’t have to be a data wizard to get this right. It’s all about keeping an eye on the right numbers and asking the right questions. So, there you have it! Dive into PBM analytics with these KPIs in your toolkit, and you’ll be setting your company up for success. It’s about making smart choices, saving money, and keeping everyone healthy. You’ve got this!

Tyrone Squires, MBA, CPBS

I am the proud founder and managing director of TransparentRx, a fiduciary-model PBM based in Las Vegas, Nevada. We help health plan sponsors reduce pharmacy spend, by as much as 50%, without cutting benefits or shifting costs to employees.

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