Pharmacy Benefit Specialists for Corporate America
Pharmacy Benefit Diagnosis Suite© (PBDS)
Detecting Excess Margin in the Pharmacy Benefit Plan
Pharmacy Benefit
Manager (PBM)
1.The PBM contracts
with pharmacies to fill
the prescriptions
2.The PBM contracts
with sponsors
Plan sponsor
Pharmacy
The PBM bills the
sponsor
The PBM pays the
pharmacy
Bill=$44
Payment = $34
Optimal price for
drug
Copyright Robert I. Garis, PhD All
Rights Reserved
10
Introduction
Pharmacy Benefit Diagnosis Suite (PBDS) is a revolutionary software application that allows
benefit sponsors to monitor prescription prices charged to the plan. We provide sponsors with a
web-enabled software application that enables the sponsor to compare their PBM drug prices to
“optimal” drug prices. We define “optimal” drug prices as realistic, attainable prices in the PBM
marketplace that are acceptable to pharmacies across the nation.
PBDS shines the light on appropriate prescription prices. We research the market and
continuously update “optimal” prices for prescription drug products. Knowledge of optimal
prescription prices is essential to controlling prescription benefit spending.
PBDS brings the power of a formerly labor intensive manual audit to the desktop computer of the
busy benefits professional. The application combines ease of use with straightforward reports that
provides powerful oversight of the pharmacy benefit manager (PBM). This application was
developed by Dr. Robert Garis, CEO of Win-Rx, LLC, a University researcher recognized as a
national leader in pharmacy benefit management.
Therefore, the corporate client can determine if the PBM is operating in their firm’s best interest. If
the PBM is taking hidden cash flows, PBDS identifies where and how much these cash flows are.
Recent Examples of Corporate
Pharmacy Benefit Plan Audits
Sponsor #1 is a Union Trust located on the Eastern seaboard. The Union has over 150,000
members. This Union has an in-house pharmacy data librarian, in-house counsel with responsibility
for PBM contracting and a national health care consulting firm.
Sponsor #1 Savings Opportunity
Excess margin identified with PBDS optimal pricing
Estimated Annual Savings
$2,104,308
Sponsor #2 is a Fortune 100 food producer. There were 30,000 employees in the division we were
asked to examine. The cash flows shown were taken by the PBM in spite of an in-house purchasing
and legal staff. The firm also retained a national health care consulting firm. Further, this firm
belonged to a national health care purchasing coalition.
Sponsor #2 Savings Opportunity
Excess margin identified with PBDS optimal pricing
Estimated Annual Savings
$1,479,630
Sponsor #3 is a small hospital system in middle America. This firm employed approximately 430
persons. The firm had, previous to the audit, taken a “hands off” approach to the pharmacy benefit.
Sponsor #3 Savings Opportunity
Excess margin identified with PBDS optimal pricing
Estimated Annual Savings
$59,600
Sponsor #4 is a State government employee benefit program. The state had over 130,000 members
in the pharmacy benefit program.
Sponsor #4 Savings Opportunity
Excess margin identified with PBDS optimal pricing
Estimated Annual Savings
$8,200,000
For more information contact:
Dr. Robert I. Garis, Pharmacist, MBA, PhD
7710 S. 171st Street
Omaha, NE 68136
402.280.3267 (office)
402.203.0229 (cell)
Email: rgaris@creighton.edu