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The Pharmacy Benefit Management Institute . Presents. AUTOPRO ä. The Automated PBM Proposal Evaluation Program. AUTOPRO - . What is It? What is It Good For? How Does It Work? Who Cares? What Makes AUTOPRO Unique?. AUTOPRO - What is it?. Set of PC-based Software Tools

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The Pharmacy Benefit Management Institute

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The pharmacy benefit management institute

The Pharmacy Benefit Management

Institute

Presents

AUTOPROä

The Automated PBM Proposal Evaluation Program


Autopro

AUTOPRO -

What is It?

What is It Good For?

How Does It Work?

Who Cares?

What Makes AUTOPRO Unique?


Autopro what is it

AUTOPRO - What is it?

Set of PC-based Software Tools

Automates the PBM Solution Process

Uses Sophisticated Computer Algorithms

PBMI Proprietary Format


Autopro what is it1

AUTOPRO - What is it?

AUTOPRO is Useful For -

Bid Issuance

Bid Evaluation

PBM Selection

Contract Negotiation

Ongoing PBM Performance Management


Autopro what is it good for

AUTOPRO - What is It Good For?

Saves 50-80% of the Time and Expense of RFP Process

Faster Decision Making

Dramatically Reduces the Volume of “Fluff”

Isolates Pertinent Facts

Saves Employee Person-Years

Saves Large Consulting Fees


Autopro what is it good for1

AUTOPRO - What is It Good For?

Higher Quality Decisions

Based on Objective Focus of Specific Needs

Requires ALL Vendors to Respond in Consistent

Format

Performance Guarantee Oriented

Lowest Overall Benefit Cost

Requires Little PBM Expertise


How does the process work

How Does the Process Work?

Prepare

RFP &

Question

Set

PBMI

Contract

=

TO

VENDORS

Needs

ID

RFP on Diskette

PBM

Ranking

Reports

Vendor

Response

Doc’s

Evaluation

Software

Decision

=

Responses

on

Diskette

Weighting

Criteria


What makes autopro unique

What Makes AUTOPRO Unique?

Designed with Extensive Industry Expertise

Constantly Updated

Most Advanced Process Available

Uses PBMI Proprietary Formats

Provides Uniform Roadmap for Evaluation

Requires Performance Guarantees with Penalties

Focuses on Total Bottom Line Cost


When do you use autopro

When Do You Use AUTOPRO?

Plans to Issue a PBM RFP

PBM Contract 2 + Years Old

Concerned with Vendor Performance

Limited Time and/or Expertise with PBM’s


The pharmacy benefit management institute

Select and respond to each section of this proposal.

Network Development

Background Information

Network Development

Network Management

Mail Order Pharmacy

Claim Processing

Eligibility Processing

Customer Services

Member Services

Management Reports

Concurrent DUR

Retrospective DUR

Formulary

Finance

The AUTOPRO RFP is divided into sections that represent the primary functions of pharmacy benefit managers.


The pharmacy benefit management institute

Each section of the proposal requires the vendor to guarantee levels of performance, identify the functions it will perform, and identify information submitted as exhibits.

Network Development Response

Select each of the following RFP sections and identify the performance levels guaranteed, the functions you will perform, and the information submitted.

Required And Guaranteed Levels Of Performance

Functionality Requested

Information Requested

Performance Penalties


The pharmacy benefit management institute

Network Development -- Performance Guarantees

Enter the performance level you guarantee.

1. The percentage of employees living in urban areas that will have access to at least 1 pharmacy within 2 miles of their homes.

95.2%

2. The percentage of employees living in suburban areas that will have access to at least 1 pharmacy within 5 miles of their homes.

87.7%

3. The percentage of employees living in rural areas that will have access to at least 1 pharmacy within 15 miles of their homes.

75.2%

The Performance Guarantee subsection requires the vendor to specify the performance it guarantees.

Guarantees are requested for the functions having the greatest impact on the vendor’s performance and on your satisfaction.


The pharmacy benefit management institute

Network Development -- Functionality Requested

Identify the functions you agree to perform.

Pharmacies are required to submit all claims via point-of-sale.

Pharmacies are required to submit claims using version 3.2 of the NCPDP standard.

Pharmacies are required by contract to submit their lowest usual and customary price.

By contract, pharmacies are not allowed to independently implement therapeutic substitution or utilization management programs of any type.

The Functionality Requested subsection asks the vendor to identify which of the other functions requested it will perform.

Identifying the functions desired eliminates the need for the vendor to submit and for you to review long, written descriptions of the vendor’s capabilities.


The pharmacy benefit management institute

The Information Requested subsection asks the vendor to identify which of the items requested it is submitting.

Network Development -- Information Requested

Identify the exhibits submitted with this proposal.

(1) Provide a file on diskette (in the format specified) that identifies the participating pharmacies.

(2) Provide a copy of the contract between the vendor and the pharmacies.

(3) Provide a copy of the pharmacy communication plan.

(1) Some exhibits can be evaluated using AUTOPRO tools, (2) some should be reviewed manually to verify the accuracy of certain aspects of the vendor’s proposal, and (3) some need only be reviewed for the vendor selected.


The pharmacy benefit management institute

Network Development -- Performance Penalties

Failure to provide network access at the guaranteed levels will result in a 2% administrative fee penalty.

Each function guaranteed in the Performance Guarantee subsection has an associated performance penalty. In some cases the penalty is a percentage of the administrative charges. In others it is equal to the excess cost you incur; for example the cost of drug utilization management savings promised but not delivered.

Collecting a financial penalty is poor compensation for the impact of your vendor’s failure to perform. The intent of the penalties is to also ensure the vendor understands your requirements for performance and make the vendor much more conscious of its performance.


The pharmacy benefit management institute

Please assign weights to each section.

Network Development

5

Network Management

15

Claim Processing

3

Total Points

100

The AUTOPRO evaluation program evaluates the PBM proposals and calculates a score for each PBM based upon their responses and the weights you assign to each proposal section and question.

With AUTOPRO, you can model different weighting schemes allowing you to emphasize different functions.


The pharmacy benefit management institute

Network

Development

Network

Management

Mail

Order

Claim

Processing

Grand

Total

Vendor1

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Vendor 2

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Vendor 3

###.#

###.#

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Vendor 4

###.#

###.#

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AUTOPRO’s evaluation program combines the vendors’ responses with the weights you assigned to create a score for each question and proposal section.


Autopro contract options

AUTOPRO Contract Options

One-time License Fee

You do the Work with PBMI Assistance

Telephone Interviews for Needs Identification

Question Set Definition

RFP Diskette Preparation

Ongoing Coaching/Assistance

Evaluation Software

Weighting Scheme

Overall Process

Assure Your Complete Satisfaction


Autopro contract options1

AUTOPRO Contract Options

Full-Service Contract

All of the Above +

PBMI Does All the Work with Your

Decision Making

Assure Your Complete Satisfaction


The pharmacy benefit management institute

Call the Pharmacy Benefit Management Institute, Inc. at (480) 730-0814 for information about this exciting new capability.


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