SXC Health Solutions, Inc.

2007 Rx Benefit Innovation Award

Problem Identification

Drug companies are spending billions of dollars to encourage consumers to request high-cost, brand-name drugs from their physicians. Both consumers and drug benefit plan sponsors could realize reduced prescription drug costs if consumers made the choice to purchase the lowest cost drug that is medically appropriate for their needs. Empowering consumers to make that choice is a challenge. Complex benefit designs make it difficult for consumers to keep track of their plan’s preferred drugs and beneficiary cost share, and discuss this information with their prescribing physicians. Consumers need access to up-to-the-minute information on their plan’s copayments and prescription costs to make educated, cost-effective decisions.

Target Audience

Drug benefit sponsors and their beneficiaries are the target audience for the SXC Health Solutions, Inc. (SXC) beneficiary decision-support tool.

Objectives

SXC sought to provide consumer-centric, easy-to-use tools to deliver real-time information and system functionality to support member-specific health care and prescription cost management. SXC considered the following factors critical in meeting the growing needs of health care consumerism:

• Enable the sponsors of drug benefit plans to engage their beneficiaries in understanding drug costs and choosing low-cost alternatives when medically appropriate.
• Empower consumers to be actively involved in managing their health care costs.
• Encourage greater use of cost-effective drugs, such as low-cost generics, to drive increased plan and consumer savings.

Solution

As an enhancement to its extensive PBM tool set, SXC built RxPORTAL™. This consumer-centric, interactive Web site enables beneficiaries to run real-time adjudications to compare the cost impact of prescription drug alternatives, based on their own benefit design. SXC launched the interactive Web site in January 2006.

Through RxPORTAL, drug plan beneficiaries can easily access up-to-the-minute information on all of the following:

• Copayments and annual costs for drug products prescribed by the beneficiary’s physician
• Copayments and annual costs for therapeutic alternatives
• Per-prescription and annual cost that the drug benefit plan pays for each drug
• Location of the nearest retail pharmacy offering the best price
• Comparison of retail cost and mail-order cost
• Quality and safety information on prescription drug alternatives
• Beneficiary’s medication claim history
• Health Savings Account (HSA) deductibles and balances

RxPORTAL can be co-branded by drug benefit plan sponsors, with customized plan sponsor messaging. Most plans sponsors utilizing RxPORTAL link to the site through a co-branded or private-label arrangement.

Results

By educating consumers about the comparative costs of prescription drugs and engaging them in a decision-making process, RxPORTAL is helping both beneficiaries and plan sponsors reduce prescription drug costs. Analysis of trial adjudications submitted through RxPORTAL indicated that nearly 40 percent of consumers who used the tool to investigate more cost-effective drug alternatives made the decision to use a lower-cost product. These consumers realized an average per-claim savings of $41.80.

Members Only     Education     Publications     Research     Track Legislation     PBM Directory     Industry Partners Directory    Join PBMI     Shopping Cart     About Us     Contact Us     Home     Site Map

Pharmacy Benefit Management Institute, LP     8679 East San Alberto Drive, Suite 101    Scottsdale, AZ 85258-4368     Ph: 480-730-0814    Fx: 480-222-4229