SKYGEN USA announces launch of Hylis Pharmacy Solutions

Citing a need to bring skyrocketing pharmacy costs under control, SKYGEN USA, the umbrella brand for a distinguished family of benefit management companies and technology solutions for health payers and healthcare organizations, today announced the launch of Hylis Pharmacy Solutions.

The new company will use its deep understanding of the inner workings of prescription drug programs, in conjunction with the world-class analytics capabilities of sister company Wonderbox Technologies' Enterprise System, to act as a client advocate. It will provide large self-insured plan sponsors with unprecedented transparency into the actual cost of delivering pharmacy benefits to their members to help reduce and control prescription drug program costs. The company will use its technology to perform a retrospective analysis on an organization's actual claims, then accurately document and report the expected savings.

"While the industry is focused on savings, the complexity of the transactions and the lack of transparency make it difficult for plan sponsors to determine whether those savings are being maximized," said Greg Borca, CEO of Hylis Pharmacy Solutions. "With our knowledge and technology, Hylis Pharmacy Solutions can pull back the veil and deliver real insight to help most plan sponsors save anywhere from 15 to 25 percent on their costs. When you're talking tens or hundreds of millions of dollars in spend, that's significant."

Preliminary estimates from IMS Health's Institute for Healthcare Informatics call for U.S. pharmaceutical sales to rise to $377 - $384 billion in 2014, or a little more than 12 percent of the projected $3.06 trillion total U.S. spend on healthcare. This is predicted to occur despite the fact that many former name brand drugs are now available in generic form. Traditionally, drug program costs double every 8 to 10 years due to underlying branded drug inflation. The result is that pharmaceuticals often constitute more than 25% of a health plan's cost.

Pharmacy Benefit Managers (PBMs) were originally created to improve the administration of prescription drug programs by adjudicating pharmacy network claims online. Through their aggregated purchasing power, PBMs have also gained the ability to negotiate with pharmacies to achieve better pricing. In addition, management techniques such as encouraging the use of generics in place of brand name pharmaceuticals and managing drug formularies also help reduce costs. PBMs are normally paid a fee for these services.

In recent years, however, the industry business model may have taken advantage of the lack of transparency in its financial transactions to gain additional revenue. For example, spread pricing occurs when PBMs pay pharmacies one cost to dispense the prescriptions, and then bill plan sponsors at a margin greater than this rate. The resulting additional profit-taking leads to increased costs for the self-insured plan sponsors or health plans. Borca says there are seven to eight of these types of practices PBMs may use to inflate the average wholesale price. They can be difficult to expose because of the complexity of the industry.

"Our experts know the PBM industry well, so they understand where to look," Borca said. "Then our technology takes over. By automating the discovery process, we look for patterns across large amounts of data and make recommendations that will have a significant impact in reducing our clients' costs."

Hylis Pharmacy Solutions is so confident in its ability to uncover issues and help organizations that it will perform an analysis of a plan sponsor's prescription drug spend free of charge. If it is determined that changes need to be made, Hylis Pharmacy Solutions' revenue comes in the form of a percentage of the realized savings, eliminating any direct cost to the plan. The company then continues to validate the data on an ongoing basis to ensure that appropriate costs are maintained.

Many plan sponsors are often disappointed to learn how much additional they have been paying over the years and are grateful that Hylis Pharmacy Solutions is finally bringing closure to this problem.

"This is an issue that affects a large percentage of the group insurance market, yet one that has been difficult to pin down," Borca said. "Our goal in launching Hylis Pharmacy Solutions is to steer pricing downward toward the best interest of the member and the plan sponsor over anyone else."