Performance Pharmacy Solutions ℠

Performance Pharmacy Solutions (PPS) is HORIZON Health Ventures, LLC pharmacy benefit management service. Delivered exclusively through some of the nation's largest and most respected pharmacy benefit managers (PBMs), our partners provide pharmacy services to more than 70% of all Americans, delivering access to retail, home delivery and Specialty pharmacy distribution. With guidance and ongoing oversight from HORIZON, our service providers develop and flawlessly implement proven solutions to address today's pharmacy challenges.

 


The unmatched scale and scope of HORIZON's experience and leverage in this critical area of healthcare delivery brings significant value to your organization. With average savings of 12-15%, our focus on delivering value to clients and their advisors is derived from the simple belief that our clients deserve our best work. HORIZON Health Ventures excels in these areas:

  • Pricing & Contract Management - HORIZON brings complete transparency and clarity to pharmacy contracting. We eliminate pharmacy pricing optics and complicated contract terms, ensuring that plan sponsors and their advisors understand the legal and service obligations of all parties.
     
  • Performance Analytics℠ - HORIZON provides payment integrity services for all sizes of clients to make certain that their selected provider adheres to the contractual obligations for which they are bound - regardless of the number of lives that they cover.
     
  • Aggressive and Progressive Pricing - HORIZON's unique service model and contracting process enables our clients to continuously improve rates as PBM pricing contracts improve and as the HORIZON book of business grows.
     
  • Implementation & Service - Since inception in 2012, HORIZON has retained 100% of the clients it has implemented.
     
  • Clinical Management & Consulting - HORIZON takes great pride in understanding the changing dynamic of the PBM industry and imparts creative, thought-leading perspectives relative to managing the pharmacy benefit.

Click here to learn more about Pharmacy Benefit Management our Performance Pharmacy SolutionsSM and how to request a quote

 

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Success Stories
Association Employer – New Jersey – HORIZON Solution: Employer Group Waiver Plan (EGWP)

Number of Retirees: 239
This Association had been managing their retiree pharmacy program and filing for the Retiree Drug Subsidy (RDS) since 2006 through its insurance carrier. After evaluation of current drug spend and projected RDS for 2014, the plan decided to move to a fully insured Employer Group Waiver Program (EGWP). Based on current enrollment, no change in plan design or drug plan, the group saved $430,000 or $1,800 PMPY. This was hard dollar savings and did not infer savings from the elimination of attestation, administration or from the elimination of OPEB liabilities.

Success Stories
Government Association - Washington, DC- HORIZON Solution: Employer Group Waiver Plan (EGWP)

Number of Retirees: 108
This Association had been managing their retiree pharmacy program and filing for the Retiree Drug Subsidy (RDS) since 2006 through its Pharmacy Benefit Manager (PBM). During the course of the relationship, the PBM never introduced the Employer Group Waiver Program (EGWP) to either the Association or their insurance broker. In May 2013, HORIZON Health Ventures introduced the concept of EGWP to the broker who immediately addressed the capability with the client. Keeping all pharmacy benefits the same, HHV was able to save this plan $189,000 or 28% of drug trend for 2014.

Success Stories
Municipal Employer –Michigan – HORIZON Solution: Employer Group Waiver Plan (EGWP)

Number of Retirees: 1,200
Managed for many years by the same carrier, this municipality moved their group retiree pharmacy program to HORIZON Health Ventures and its proposed Employer Group Waiver Program (EGWP) for a 13% savings to the plan. In addition, the group did so while improving their plan design on generic drugs. At the direction of HORIZON Health Ventures, the EGWP provider lowered copayments on generic products both at retail and mail thus resulting in greater steerage to lower cost products and thus a lower premium. In addition, based on this client’s plan year, (along with the new plan design adopted), the client was able to secure a rate cap for 2015 fixing their costs at a maximum liability until January 1, 2016.

Success Stories
Union – New Jersey – HORIZON Solution: RDS Reopening

Retirees Covered: 1,032
Reopening subsidy = $1,518,000
Additional subsidy = $280,000
18% additional subsidy recovered upon Reopening

Upon hiring HHV and RDS Reopening Services requested an audit of past Retiree Drug Subsidy filings from CMS. The request was approved and based on missed eligibility and inaccurate reconciliation of subsidy eligible claims, this client successfully Reopened their RDS filings from 2009-2012 recovering over $90,000 in additional subsidy. 

Success Stories
Municipality – New Jersey – HORIZON Solution: Pharmacy Benefit Management

Total Lives Covered – 2,900
Annual Drug Spend - $4,400,000
Issue – Adverse drug mix in the Proton Pump Inhibitor (PPI’s) category resulting in $297,000 in unnecessary drug spend.

Resolution – Plan design modification mandating PPI’s be purchased Over-the-Counter (OTC) along with full subsidy of a $0 copayment to the member.

Recommendation to eliminate member cost share for mandatory purchases of OTC PPI’s resulting in $177,000 net savings to the plan. Significant savings to both plan and member realized through slight modification of design and no member disruption.

Success Stories
Corporate Employer – Pennsylvania – HORIZON Solution: Medical Bill Review

Total Lives Covered – 400
Number of bills reviewed - 5
Total Amount of Hospital Bills Reviewed - $1,135,914
Negotiated Amount Paid by Plan Sponsor - $446,874

After hiring HHV for Cost Containment Services (Medical Bill Review), five out-of-network hospital bills (different patients with different health conditions) were reviewed for appropriateness and necessity. Due to the identification egregious billing practices, undocumented charges and reasonableness audit, successful negotiation was realized reducing the amount paid by $690,000.

"The simple truth is that American's failure to take medications as prescribed costs the nation billions of wasted dollars annually.  The need to address both the immediate costs of nonadherence and its long-term consequences has never been greater.

Express Scripts 2011 Drug Trend Report