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Benefit administration firm SKYGEN USA on Tuesday launched a data analytics company, Hylis Pharmacy Solutions, which aims to save self-insured employers costs associated with nontransparent pharmacy benefit contracts.
By analyzing past claims data, Mequon, Wisconsin-based Hylis provides self-insured employers with the actual cost of delivering pharmacy benefits to their members, looks for reasons the employer may be paying too much, and offers recommendations on how to help reduce and control group prescription drug benefit costs, according to a company statement released Tuesday.
The firm claims to be able to deliver between 15% and 25% savings, Hylis said in the statement.
PBMs administer prescription drug programs for employers and negotiate with pharmacies to achieve better pricing, Hylis said. They also often work to reduce the cost of group prescription drug programs by developing formularies and encouraging the use of generic drugs over brand name pharmaceuticals, Hylis said.
But there is often a lack of transparency in how PBMs make their money, according to the statement. For example, some PBMs engage in spread pricing, meaning they pay pharmacies one amount to dispense the prescriptions, but bill plan sponsors at a greater margin and pocket the difference, Hylis said.
Hylis will perform an analysis of a plan sponsor's prescription drug spending for free, and will charge a percentage of the realized savings if changes need to be made to the pharmacy benefit program, according to the statement.
Hylis said it will continue to validate the data on an ongoing basis to ensure savings are maintained.
“While the industry is focused on savings, the complexity of the transactions and the lack of transparency make it difficult for plan sponsors to determine whether those savings are being maximized,” Hylis CEO Greg Borca said in the statement. “Hylis Pharmacy Solutions can pull back the veil and deliver real insight to help most plan sponsors save anywhere from 15 to 25 percent on their costs.”
Few workers compensation prescriptions are filled via mail order despite lower prices for payers and increased compliance by injured workers, experts say.