PLAN DESIGN ANALYSIS
Aligning incentives with plan objectives.
Many prescription benefit managers (PBM’s) have their own mail service and specialty providers. Some even own the retail stores which provide a majority of the prescriptions. We often see PBM’s recommending incentives to the member to use mail service. If structured correctly, this can benefit both the plan and the member. If the copays are too low, the plan can actually lose money when a mail service claim is filled.
HealthLinX (HLX) uses your actual claim data and reimbursement structure to calculate the break-even point in the plan structure. By finding the absolute best return to the plan, adjustments in favor of the member can be assessed financially and a conscious decision can be made by the plan on the benefit design.