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Advanced Medical Strategies Reveals Manufacturer Rebates

Advanced Medical Strategies (AMS), an industry leader in delivering technology-driven solutions for payment integrity, risk management, and high dollar claims issues, has partnered with Health Delegates to gain members access to the true rebates that are being paid for drugs on a per-NDC level. This manufacturer rebate data is a major addition to PredictRx, AMS’ specialty drug database that evaluates and predicts dosing regimens and their associated costs.

 

Nic Andre, AMS Product Development Manager: “While we are excited about the many recent upgrades and additions to PredictRx, we are most eager to release the new rebate data in partnership with Health Delegates. We constantly seek new opportunities to deliver crucial data and information of immediate benefit out of the box to Predict Suite members. We are confident they will be thrilled to have this information at their fingertips; after all, it was a request directly from many of them at our annual member forum! Thanks to Mark Huetten, CEO at Health Delegates, AMS continues to move ever-closer to revealing the true costs of medicines for our Predict Suite members who rely on this critical information to make informed business decisions.”

 

The first benefit of the update is inclusion of NDC codes within PredictRx. NDCs, or National Drug Codes, are universal product identifiers for U.S. drugs. These 10- or 11- digit codes identify a drug with a unique ID down to the specific packaging it comes in. Within PredictRx, all NDC Package Codes for a particular drug are listed along with a package description and strength of corresponding dose. This NDC data is valuable in that members may now directly search across the suite by NDC to immediately identify the specialty drug appearing on the claim.

However, NDC functionality becomes doubly valuable when coupled with Health Delegates’ manufacturer rebate information. Drug manufacturers offer rebates on specific drugs to purchasers with varying contractual conditions. To payers, these rebates are opaque; they are often pocketed by PBMs without the payer even knowing a rebate was available. This makes managing the cost of specialty drugs unnecessarily difficult for claims professionals, as sometimes the very entity that is supposed to be reducing drug spend is pocketing additional savings on top of the profit already made through the drug price spread.

 

To combat this, Health Delegates and AMS have teamed up to deliver another level of transparency for claims professionals. Members will now find average rebate ranges for drugs in PredictRx on a per-NDC level, as well as the ability to contact Health Delegates for further information. The newly added data gives visibility into previously uncharted territory; claims professionals using the Predict Suite now have hard data showing that additional savings on specialty drugs through their PBM may be available. Not only does this data level the playing field in the fight to reduce specialty drug costs, it also provides actionable information to solve an identified problem many payers struggle with in the self-funded space.

 

“We are very excited about our partnership with AMS,” says Mark Huetten. “PredictRx enables claim professionals to analyze rebate dollars by NDC, and provides vital information when determining the net cost of a given drug. This information can lead to better decision making by payors, and ultimately lower costs for plans and patients.”

 

About AMS

Advanced Medical Strategies is an industry leader in delivering technology-driven solutions for payment integrity, risk management, and high dollar claims issues. Its predictive analytical software and decision support services help solve the critically important strategic problems of multiple stakeholders along the medical claims payment chain, those of which include commercial and governmental payers, Stop Loss and Reinsurance Carriers, MGUs, Medical Management Firms, Health Plans, TPAs, HMOs, Taft-Hartley Plans, workers compensation, and auto medical carriers.

 

About Health Delegates

Health Delegates currently manages pharmacy rebates for more than 3 million PBM, Health Plan, Taft Hartley, and large employer lives. Health Delegates has strategic and aggressive direct manufacture rebate contracts, as well as arrangements with key third party aggregators in place. Our transparent Pharmacy Rebate Management model enables our clients to significantly increase rebate dollar returns, and lower net drug cost. Health Delegates is PBM agnostic, and passes through all rebate dollars (minus our transparent admin fee) to our clients.

To learn more or to schedule a demo, please contact Stephanie, 781-224-9711 ext. 116, stephanie@mdstrat.com