Our Predictive Model has the ability to take your claims history
and predict next year’s pharmacy expense. The model is loaded
with the last two years claims experience. By use of several “sub-models”
the program extends the results to the current year’s end
and then predicts the trended result for the next year. The model
has been approved by actuaries and allowed to be used in our underwriting
of insured pharmacy premiums.
The operative screen is shown below. Changes to the yellow colored
input cells allows the user to view year ending results of any “what–if’s”
considered for benefit changes.
- Pricing options allows the user to consider different contract
- Copay scenarios of “flat dollar” or “percentage”
copays (or combination) can be tested. Even optional copay maximums
can be considered.
- Member Share (grey cells) are shown as a percent are recorded
with each move to allow the user to compare “buckets”
and enable the changes to hit copay expectations.
- Options of Plan Maximums, OOP Maximums and Deductible are all
calculated from several linked “sub-models”
- With additional input of Admin Fees and Rebate, a “Projected
Year” drug spend is instantly calculated in the green colored
- The columns on the left are the basic drug coverage categories.
Changes of input (X) will use another “sub-model”
and show the resulting expense with or without selected coverages
- The blue box shows the potential “savings” as changes