Delve into the complexities of the pharmacy industry as the challenge of managing drug-level guaranteed rates with pharmacies and insurers arises. With the potential for end-of-year liabilities due to under or over-performing those rates, a solution that minimizes risk becomes crucial.
Join us on a journey of optimization as forecasting drug utilization through Timeseries Forecasting and optimizing drug prices through Linear Programming takes center stage. Witness the power of a productionized optimization engine, developed with a GCP Kubernetes Pipeline, as it efficiently navigates the landscape of pricing complexities. The impact is undeniable, as monthly publications of optimal prices for over 26,000 drugs are made available to different pharmacies and insurers.
With savings amounting to $20 million per month, this groundbreaking approach not only ensures cost efficiency but also fosters stronger partnerships with hundreds of insurance clients. Prepare to embark on a transformative path where optimal pricing unlocks a new era of success in the pharmacy industry.
A leading Fortune 500 health solutions company boasting a vast network of over 9,900 locations operated a Pharmacy Benefits Management(PBM) system that relied on Price Guarantee Contracts. These contracts were established with insurers and pharmacies at the beginning of each year and were based on drug utilization.
Although these guarantees provided stability and predictability, they also harbored the potential to create liabilities for the Client by the year's end if deviations from the projected drug utilization rates occurred, whether through underperformance or overperformance.
Thus, the PBM looked to attain optimal pricing structures that would strike a delicate balance, all in the pursuit of minimizing year-end liabilities for both pharmacies and insurers, despite the uncertain utilization of the drug throughout the year.
Understanding the Client’s predicament, Blend360 stepped in with a range of strategic solutions to the Client's challenges:
1) Timeseries Forecasting
· Harnessing Timeseries Forecasting enabled the Client to accurately forecast drug utilization patterns throughout the contract period for better decision-making and more efficient resource allocation.
2) Linear Programming
· By leveraging Linear Programming to optimize drug prices, the Client strategically aligned themselves to achieve minimum liability at the end of the year, effectively mitigating the risk of potential financial burdens.
· The process of productionizing the optimization engine provided the Client with an efficient pipeline run, resulting in streamlined operations.
4) Develop a Google Cloud Platform (GCP)Kubernetes Pipeline
· The development of a Google Cloud Platform (GCP)Kubernetes Pipeline facilitated the orchestration of complex workflows, ensuring scalability, reliability, and seamless execution of the various data-driven processes.
Blend360's strategic expertise and approaches to the Client's drug pricing challenges resulted in a transformative operational shift, leading to significant accomplishments. This includes successfully creating a monthly publication of optimal prices for different pharmacies and insurers, as well as monthly savings.