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
The Automated PBM Proposal Evaluation Program
What is It?
What is It Good For?
How Does It Work?
What Makes AUTOPRO Unique?
Set of PC-based Software Tools
Automates the PBM Solution Process
Uses Sophisticated Computer Algorithms
PBMI Proprietary Format
AUTOPRO is Useful For -
Ongoing PBM Performance Management
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
Higher Quality Decisions
Based on Objective Focus of Specific Needs
Requires ALL Vendors to Respond in Consistent
Performance Guarantee Oriented
Lowest Overall Benefit Cost
Requires Little PBM Expertise
RFP on Diskette
Designed with Extensive Industry Expertise
Most Advanced Process Available
Uses PBMI Proprietary Formats
Provides Uniform Roadmap for Evaluation
Requires Performance Guarantees with Penalties
Focuses on Total Bottom Line Cost
Plans to Issue a PBM RFP
PBM Contract 2 + Years Old
Concerned with Vendor Performance
Limited Time and/or Expertise with PBM’s
Select and respond to each section of this proposal.
Mail Order Pharmacy
The AUTOPRO RFP is divided into sections that represent the primary functions of pharmacy benefit managers.
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
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.
2. The percentage of employees living in suburban areas that will have access to at least 1 pharmacy within 5 miles of their homes.
3. The percentage of employees living in rural areas that will have access to at least 1 pharmacy within 15 miles of their homes.
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.
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 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.
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.
Please assign weights to each section.
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.
AUTOPRO’s evaluation program combines the vendors’ responses with the weights you assigned to create a score for each question and proposal section.
One-time License Fee
You do the Work with PBMI Assistance
Telephone Interviews for Needs Identification
Question Set Definition
RFP Diskette Preparation
Assure Your Complete Satisfaction
All of the Above +
PBMI Does All the Work with Your
Assure Your Complete Satisfaction
Call the Pharmacy Benefit Management Institute, Inc. at (480) 730-0814 for information about this exciting new capability.