PHSL’s Clean Room PSAO Evaluation for Pharmacy Chain
Industry
Retail Pharmacy
Problem
A retail pharmacy chain was looking to evaluate alternative PSAO providers. However, based on confidentiality agreements, the PSAO could not supply their specific rates to the pharmacy chain, and the pharmacy chain could not provide claims detail to the PSAO.
PHSL Solutions
PHSL operated a clean room to perform an independent analysis for the PSAO and pharmacy. PHSL was able to provide a data template to both parties to collect de-identified claims detail and then independently received claims detail from both the pharmacy chain and PSAO. PHSL used the PSAO’s pharmacy reimbursement rates, as seen in actual claims data, to re-price the retail pharmacy’s claims.
Results
This analysis enabled PHSL to provide an anticipated revenue impact estimate to the retail pharmacy chain, allowing them to make a more data-driven decision regarding a PSAO switch. The data was provided in a rolled-up manner that did not disclose any of the PSAO’s specific PBM/health plan rates and was thus in compliance with all parties. PHSL’s analysis enabled the retail pharmacy chain to make an educated decision on their PSAO, based on quantitative metrics.