Clear Impact logo

Clinical Services Team

Ret: Adjusted $$ Pharmacy Spend (actual spend minus invoiced rebates)

Current Value

$29.65Mil

SFQ2 2023

Definition

Line Bar

Notes on Methodology

Story Behind the Curve

This measure is important because it monitors estimated net spend on pharmaceuticals and identifies any changes in the spend trend. This report tracks net spend to help optimize rebate opportunities and utilization management programs. 

This performance measure estimates net drug spending by subtracting all rebates invoiced from gross payments to pharmacies.  Net cost is driven by both pharmacy payments and rebates. Achieving the lowest possible net cost is driven partly by managing pharmacy reimbursement through optimal management of pricing methodologies such as the State Maximum Allowable Cost (MAC) program and Specialty Drug MAC. In addition, rebate optimization is driven by tightly managing the Preferred Drug List (PDL). Factors guiding our PDL decisions include both clinical appropriateness and consideration of drug acquisition cost, federal and supplemental rebates. Non-preferred products are managed through strategies such as prior authorization, quantity limits, and step therapy. 

There are regular fluctuations based on drug mix and seasonal variations, the trendline has been relatively stable. There was an incline in spend in SFY22 quarter 3.  This was attributable to an increase in specialty drug utilization which tends to be higher cost claims due to enrollment increases as well as fluctuations in rebates invoiced.

Narrative last updated:  12/29/22

Partners

  • Change Healthcare
  • Pharmaceutical Manufacturers

Clear Impact Suite is an easy-to-use, web-based software platform that helps your staff collaborate with external stakeholders and community partners by utilizing the combination of data collection, performance reporting, and program planning.

Scorecard Container Measure Action Actual Value Target Value Tag S A m/d/yy m/d/yyyy