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FIA is a unique service that allows the pharmaceutical industry to measure the impact of popular utilization-control measures used by managed care organizations, including tiered co-pay benefit designs and prior authorization restrictions.
Key Measures
Parameters measured in FIA:
- Paid claims
- Payer-rejected claims
- Patient-reversed claims
- Claims submitted
- Substituted rejected claims
- Substituted reversed claims
- Out-of-pocket cost analysis for paid, reversed, and reversal substituted claims
- Out-of-pocket differentials between reversed and reversal substituted claims
- Days supply
- National and regional account analysis
Product Benefits
- Provides you with the data you need to measure the impact of business being lost due to managed care organization (MCO) restrictions and patients’ price sensitivities
- Identifies payer-specific friction at the pharmacy and empowers managed care account teams to positively influence market share
Methods
- The data are projected to represent total retail claims
- Rx switch data analyze both directions of the claims process – what was submitted and what was adjudicated, providing a view of reject and reversal data
- The analysis focuses on those reject codes that a pharmaceutical company can act upon, but all reject codes are available for analysis
- SDI utilizes a look-forward window to identify true rejects instead of attempts
What business questions does this product answer?
- What effects are competitors, generics, and MCO-imposed cost- and utilization-control measures having on a product line?
- What drugs are being substituted for your product by both the payer and patients?
- What effects are individual restrictions and co-pays having on your product line?
- At what price points are patients refusing your product for competitors?
Deliverables
The frequency of deliverables can be monthly, quarterly, or custom. The first delivery includes a 6-month retrospective look at the drugs in the therapeutic class. For each market contracted, the customer will receive Excel spreadsheets with supporting PowerPoint slides. This analysis will include:
- Reject and reversal rates
- Patient out-of-pocket cost analysis
- Reject reason codes
- Product substitution for rejects
- Product substitution for reversals
- Out-of-pocket cost analysis for paid, reversed, and reversal substituted claims
- National and regional account analysis
- Top payers for your product and the market for rejects and reversals
For more information, please contact us.
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