Healthcare Tech Company Disrupts Billion Dollar Pharmacy Benefits Industry

The state of the prescription drug market in America has reached a crisis point, according to a release.

Twenty-eight percent of Americans are on high deductible health plans and 26% report not taking the drugs they need because they can’t afford to buy them.

Self-insured companies struggle to offer the level of benefits their employees need at a price they can afford. Additionally, health plans have to continue raising prices in order to keep up with the costs of prescription drug coverage.

The root of this problem is a complex and layered prescription drug marketplace which is shockingly confusing and hard to navigate, the release says.

The true prices of the important drugs people take daily are nearly always unclear to every party involved. The market can be unbalanced with the suppliers dictating the market dynamics and the buyers (companies, healthplans, and patients) all at the mercy of a market that changes every day, and requires deep expertise to understand. 

However, Scripta Insights, a healthcare IT solution, is bringing transparency to the prescription drug market and finding 46% savings opportunities for payers.

Related: Michigan’s Medicaid Program Plans to Save Millions By Eliminating PBMs

Scripta was originally developed by a doctor, Paul Bradley, who was frustrated by the high cost of prescription drugs and the impact this had on his patients. As a physician, he rarely had insight into how much a certain medication would cost his patients. Making matters worse, his patients didn’t discover the price of the medication until they filled it at the pharmacy, leading to many patients making difficult budgetary decisions that may be detrimental to their health. Lastly, payers, who are partially or entirely funding the member’s prescription drug, are unaware of their share of the cost until 45 days after the purchase is made when their PBM bill arrives.

Working with his wife, Mindy Bradley, a CPA, Paul recruited other physicians in every specialty, and began to devise strategies for their patients to save money on prescription drugs, and to code these strategies into a database. Led by Mindy, this effort eventually grew into Script.AI, a powerful software that uses advanced analytics and AI to solve the “big data” challenge that is pharmacy benefits, the release says.

“Technology has proven time and again to be the great leveler of the playing field," says Eric Levin, CEO, Scripta Insights. "By using technology to bring unprecedented transparency to the pharmacy benefit market, on average, Scripta is able to identify a 46% savings opportunity for payers. In the first half of 2019 alone, there were more than 4,400 price increases on prescription drugs, compared to just 46 price decreases. The market is complex and requires intense knowledge of medicine and pharmacy. Our advanced technology tools are capable of staying on top of this rapidly evolving market, allowing payers to take control of their pharmacy benefit spend, every member, every transaction, every day.”

According to the release, Scripta’s software enables three key advances in pharmacy benefit cost containment:

• PBM Optimization: Scripta’s software breaks down pharmacy spend into 27 actionable categories to enable payers to have educated discussions and enhanced negotiations with their PBM partner to find every opportunity to control costs.

• Data Driven Plan Design: Once a company better understands its population and its drug utilization, a payer can make changes to their plan design to best align incentives and reduce costs.  Rather than just benchmarking to similar companies, payers get completely customized plan design based on data insights.

• Member Savings Benefits: Scripta provides customized reporting with intelligent recommendations and savings strategies to members so they can have informed discussions with their doctor about their treatment options and the cost impact of different choices.

Scripta maintains a Pharmacy & Theraputics (P&T) Committee of more than 25 doctors and pharmacists who review and advise on medications and potential substitutions, the release says.

They inform and constantly update their proprietary Medicine Mapping and Pricing Database-enabling Scripta’s customers to have the transparency and expertise needed to become better, smarter buyers of pharmacy benefits and prescription drugs.

For more information about Scripta Insights, visit www.scriptainsights.com.