CarelonRx clients use RxGuide to make data-driven decisions

August 23, 2022 | Download PDF

In 2021, CarelonRx launched RxGuide, an intuitive, self-serve digital reporting tool. RxGuide empowers users to track, report on, and respond to key performance indicators (KPIs), such as plan pharmacy costs, per member per month (PMPM) costs, drug utilization data, and member demographics. We created RxGuide in response to market research showing data tracking as the third most important feature of a pharmacy benefit manager (PBM) to our clients.[1] Using RxGuide, our clients can confidently make potential health-improving, cost-saving decisions, knowing they’re backed by powerful data.

CarelonRx plan sponsors and brokers can use RxGuide at no added cost. Instead of relying on external vendors, RxGuide users can independently monitor pharmacy spend analytics and generate custom reports. “The tool is very fast and interactive,” says Marissa Bateman, Director of Reporting and Data Analytics at CarelonRx. RxGuide loads in seconds, and our team updates the application monthly with the latest benefits usage data. Clients can personalize their dashboards with dozens of custom tools. From there, they can explore trends and make plan improvements with the help of CarelonRx account managers.

RxGuide breaks down companies’ costs, such as total plan cost PMPM and member cost share. It also provides a more in-depth view into subcategories of these trends, including formulary versus nonformulary, specialty versus nonspecialty, and generic versus brand-name drugs. RxGuide’s data is uniquely benchmarked by industry, age group, funding type, and line of business. Users can analyze data from the past and future at the same time, getting a full timeline of their relationship with CarelonRx.

Our goal is to make RxGuide as customized as possible and connect it with other CarelonRx tools to benefit our clients and members. In one example, we linked RxGuide to a major client’s insights and analytics tool. Now the client’s medical data and RxGuide’s pharmacy data are available in one place, with no need to access additional programs or websites.

Use Case: HR Manager Finds Key PMPM Drivers[2]

Sara, a human resources (HR) manager, sees her company’s PMPM costs have increased over three straight months. She asks her CarelonRx Account Manager, Jeremy, what could be driving this trend. Jeremy uses RxGuide to dig into detailed cost data. He finds that Sara’s member cost share is less than her competitors. Jeremy wants to monitor these numbers going forward, so he customizes Sara’s dashboard to track trends and effectively manage her company’s pharmacy plan.

Jeremy also wants to search for ways in which Sara’s PMPM savings can be reached without negatively affecting her employees. He uses one of the many modules available to model plan savings if certain changes were made to the plan’s design. He also understands, however, that this network would change which pharmacies are available to Sara’s employees. Jeremy customizes her dashboard to include the Network Adequacy tool. He toggles from “Base” to the “Advantage” network and sees that most members still live within a two-mile radius of the nearest pharmacy. Jeremy exports his findings into a slide deck and shares it with Sara.

Months later, after the plan design changes have been put into action, the company’s PMPM costs are trending down.

What’s Next for RxGuide

Knowing the value RxGuide can deliver, we are expanding its features, as well as who can use it.

Upcoming additions to RxGuide include data sorting by location, a specialty pharmacy management module, and opportunity analysis features. One of the most-anticipated upgrades is the forecasting tool. Clients will be able to see side-by-side displays that compare plan designs. The data can help answer client questions, such as “How would trends change if I purchase a new product?” “What will I save?” and “How will this change help my members?” CarelonRx plans to launch RxGuide to consultant groups and additional clients in 2022.

RxGuide is just one example of CarelonRx’s digital-first solutions. “It has been a big win,” says Bateman. We look forward to growing this tool and empowering more CarelonRx plan sponsors to make well-informed, data-driven choices about their pharmacy benefits.

[1] IngenioRx internal research, October 2021.

[2] Fictional example for illustrative purposes only.