Successful Mid-Year PBM Conversion
RxEDO, the country’s first Prescription Benefit Partner, teams up with a major health plan to successfully convert their prescription drug benefit administration on July 1, 2014.
Security Health Plan has been named one of the nation’s best health insurance plans for ten consecutive years. One reason Security Health Plan is consistently at the top is the ongoing pursuit to always be above and beyond status quo. During the last quarter of 2013, Security Health Plan began to analyze its pharmacy benefits operation. The Health Plan determined that it was not satisfied with service levels and costs with its PBM. That’s when Security Health Plan andRxEDO began discussing the possibility of a partner relationship. The two companies devised a plan to accommodate Security Health Plan’s goals.
RxEDO, an eleven-year veteran in the prescription drug administration industry, has always put the interests of its clients first. RxEDO works to understand the unique issues and challenges that face each of its clients and prospects. When RxEDO studied the health plan industry, and began talking with Security Health Plan, it became evident that a 1/1 conversion of prescription drug administration services was probably not the best way to approach changing the Health Plan’s claims processing system. Twila Johnson, Director of Pharmacy Services at Security Health Plan, stated, “The trend for health plans was and still is to try to convert plans at the start of a plan year, reducing the complexity involved with matching accumulators. There is also risk inherent in a mid-year conversion from potential issues that would cause exposure with CMS regarding member balances being incorrect. RxEDO helped us prove a mid-year conversion could be successful.” Leadership at Security Health Plan decided that as long as the focus was on thorough planning and testing, the added flexibility and avoidance of other year-end obligations outweighed the risk.
On July 1, 2014, all of Security Health Plan’s prescription drug claims were converted to RxEDO. Had the transition to RxEDO been a standard year-end conversion, the success markers would still have been excellent. However considering the fact that Security Health Plan converted to RxEDO mid-year, the accomplishment was remarkable indeed.
RxEDO and Security Health Plan had adequately prepared for the conversion and for the additional challenges arising from Security Health Plan moving its prescription drug program mid-year. For example RxEDO had already successfully analyzed members’ historical accumulators and RxEDO correctly loaded the members’ data, so that the claims history was accurate and the members remained in their appropriate phase (bucket) when the conversion occurred. The preparation proved invaluable.
The RxEDO/Security Health Plan implementation teams working as partners with a mutual goal, successfully completed the conversion.
Dr. Mark LePage, Security Health Plan’s Chief Medical Officer, said, “We are very pleased with RxEDO. The conversion was great and RxEDO’s service is exceptional. Our members are happy. The administration of the prescription drug program is operating smoothly, and RxEDO is very responsive to our every need. It is wonderful to have a Prescription Benefit Partner that understood our needs, and then built a program specifically for us. I highly recommend RxEDO, and I am happy to visit with anyone about this experience.”
RxEDO’s pricing model is unique, and cutting edge. RxEDO’s pricing model is transparent, in all respects. RxEDO charges a modest administration fee on each claim processed. There are no mark-ups on prescription drug charges and no hidden drug spend spread. In the end RxEDO’s pricing model creates lower net drug costs for its clients!
RxEDO’s Future in the Health Plan Industry
RxEDO is excited about the impact it is having at Security Health Plan. RxEDO’s first mid-year conversion was a huge success, and Security Health Plan is reaping the benefits, through great service and significant savings. RxEDO’s deliberate focus on the precise needs of Security Health Plan was well worth the investment. As partners RxEDO and Security Health Plan have opened the door to a brand new way of converting prescription drug administration programs… any time during the year! RxEDO is committed to further development of new and innovative ways to service their clients.