Our Value-based Reimbursement Model
for Prescription Drug Benefits

Reduce total drug spend by up to 20% without making changes to your formulary.

THROUGH RIGOROUS CLINICAL EVALUATION OF ALL DRUGS IN OVER 125 THERAPEUTIC CATEGORIES,

ActiveRADAR first establishes which drugs are clinically equivalent and therefore therapeutic alternatives to one another.

This creates our Clinical Catalog of over 29,000+ therapeutically equivalent “perfect pairs”.

Then ActiveRADAR determines the economic value using plan specific data to value each drug within its respective

therapeutic class and sets pricing and reimbursement accordingly. This type of program has historically been called

“reference pricing”, however ActiveRADAR takes it a step further by establishing both

THE CLINICAL AND ECONOMIC VALUE OF EACH AND EVERY DRUG IN EACH THERAPEUTIC DRUG CLASS.

4 Key Elements of the ActiveRADAR
Value-Based Reimbursement Program.

Vigorous clinical evaluation: clinical data supports what is therapeutically appropriate and equivalent.

Timely and accurate analysis and reporting.

Effective Member, Provider, and Pharmacy education and communication.

Technology that Integrates ActiveRADAR Algorithms into PBM Real Time Benefit Check or Claims System.

ActiveRADAR prepares a Summary of Evidence on each
and every one of the over 125 therapeutic categories for review and approval by our Pharmacy and Therapeutics Committee. The Summary of Evidence reviews all the clinical guidelines, medically accepted use, comparative outcomes evidence, adverse effects, and any unique features of all the drugs in each therapeutic class.

Statin Drug Class Example: We evaluate all 67 drugs in the
class and determine the best clinical and economic value for
each drug. For instance, clinical evidence indicates that rosuvastatin 10mg is clinically equivalent to atorvastatin 20mg.
Atorvastatin provides an 83% discount off rosuvastatin’s current reimbursement rate. We conduct this arduous clinical and
economic evaluation for each of our 103 therapeutic drug classes.

ACTIVERADAR VALUE-BASED REIMBURSEMENT OUTCOMES

Analytical processes target and prioritize savings opportunities to minimize member impact and maximize

savings. There is no change in PBM, and

Plan Sponsors save 15%-20%

while Members can save $5-$10 per script or more on Prescription Drug costs.

ACTIVERADAR VALUE-BASED REIMBURSEMENT PROCESS

Economic evaluations establish the “Fair Market Value” for each drug in each therapeutic drug class. This process weeds out the

“me too” drugs and establishes the clear maximum amount that should be paid for a drug in each of our therapeutic drug classes.

ACTIVERADAR VALUE-BASED REIMBURSEMENT VALUE

Successfully saving our partners money for over 14 years.

Academically studied, peer reviewed and published in the New England Journal of Medicine and JAMA.

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