Healthcare cost has been a major cause of concern for US economy for quite some time now. The total expenditure on prescription drugs in the U.S. was about $307 billion in 2010 which is about 12.9% of the total U.S healthcare spending and is forecasted for continuous growth. The Prescription Drug Plan was a bold move to insulate the elderly against this huge burden. However, rising drug prices and competitive bids have made administering these plans a challenge for PDP plan sponsors. The key challenges for health plans continue to be beneficiary retention, lowering MLRs and administration costs. Taking these into consideration, Health Technolgy developed PDP Manager Platform which is sure increase beneficiary satisfaction and health, improve operational efficiencies of clients and reduce cost by 35-70%.
In light of the rising premiums and changes in the benefit design since the inception of the Part D program, it remains important for consumers to compare plans every year and make informed decisions, based on the coverage and costs for the medications they take. However, lack of sufficient research and monitoring makes it all the more challenging to evaluate the impact of both the existing trends and any changes, stemming from recent statutory and regulatory changes, in order to ensure that the Medicare Part D program serves beneficiaries well.
Medicare Part D plans are an important source of prescription drug coverage for about 60 percent of the 47 million Medicare beneficiaries in 2010. However, recent study has revealed significant increase in premiums, cost-sharing amounts, use of specialty tiers, and utilization management restrictions, since 2006. This can have significant implications on beneficiaries’ access to needed medications and out-of-pocket expenses.
Most PDPs do not offer coverage in the coverage gap, and those that do primarily cover generics tend to cover fewer generics, during the gap, than in the initial coverage period. It is also seen that the number of Medicare stand-alone prescription drug plans (PDPs) is on the fall. As of 2011, the number of PDPs is 1109 compared to 1429 in 2006 as shown in the below diagram.
Source:Georgetown/NORC analysis of CMS PDP Landscape
Sun Knowledge’s PDP Manager Platform has wide array of applications catering to needs of various verticals of Medicare Part D operations. This aims to help Part D providers with improved quality of care, reduce risk, cut costs and increase revenues. The PDP Manager application empowers the Part D providers with better manageability of business processes and simplified approach towards handling day-to-day and milestone operations involved with the business processes. With function specific business rules encapsulated in its rule engine and auto-scheduling of jobs, PDP Manager not only helps in reducing the manual errors but also speed up the process work. The users are sure to be benefitted by our standalone platform.
Some of the key features of PDP Manager Software are as follows:
Online Medicare Eligibility Verification during enrollment processing
Built-in edit and validation rule for enrollment, changes and disenrollment
Enrollment Transaction Validation and 4Rx creation
Creation and Submission of enrollment transactions to CMS
TRR processing and update member data
Member Correspondence triggers based on TRR
BAE request tracking and update
LIS Match rate file generation
Daily Eligibility file creation and transmission to PBM system
Premium statement generation
Processing of payment through credit card / EFT
The software solution is built on enterprise class Java architecture and uses SQL Server 2005 as its back-end database. The software system is run on state-of-the-art hardware and network devices that are designed to be scalable and reliable for 24x7 operations with redundancy at the server and database level. The application framework facilitates automated data exchange with external interfaces. The platform accommodates changes as per the changes in Medicare requirements and user organizations.