HealthPlan Data Solutions Presents Positive Results of New Pharmacy Payment Integrity Program at Kentucky Legislature's Interim Joint Committee on Health Services

On September 27, 2023, HealthPlan Data Solutions (HDS) executives presented initial results from its pharmacy payment integrity program implemented with the Kentucky Employees' Health Plan (KEHP) during an Interim Joint Committee meeting on Health Services. In the first half of 2023, the implementation of Claim Scan led to meaningful error recoveries for KEHP with their contracted pharmacy benefit manager and most importantly helped return incorrectly calculated insulin copayments directly to Kentucky patients.

HDS was selected by the Commonwealth of Kentucky in 2022 to establish a pharmacy payment integrity program beginning in 2023 as part of a revision to KRS Chapter 18A (18A.225). This revision required the appointment of an independent, third-party vendor to monitor all pharmacy benefit claims for the public employee health insurance program. A copy of KRS Chapter 18A revision 0.225 can be found here.

Deputy Commissioner, Chris Chamness, stated that, "Though HDS's services with our health plan have just recently been applied, the Kentucky Employees' Health Plan has developed a positive working relationship with HDS through the implementation process." As part of the revised legislation, HDS also has submitted quarterly reports to the Kentucky Legislative Research Commission (LRC) to provide a summary and analysis of all errors identified throughout the payment integrity process. Copies of the first two quarterly reports provided to the Kentucky LRC can be found here.

HDS CEO, Ron Hamm said, "We are extremely proud of the work we've done to implement Claim Scan for KEHP. They have been tremendous partners, and we believe the savings we've delivered for the taxpayers of Kentucky speak for themselves." Hamm further applauded the members of the Kentucky General Assembly and leaders of the Interim Joint Committee on Health Services for their vision, leadership, and tenacity to enact legislation to help safeguard the taxpayers of Kentucky.

State Representative Kim Moser, Co-Chair of the Interim Joint Committee on Health Services, stated that, "The Kentucky General Assembly has made it a priority to increase oversight of our Commonwealth's pharmacy benefit managers. Over this past year, HDS has successfully delivered on our vision by enabling greater transparency and establishing pharmacy payment integrity between KEHP and their contracted PBM. Their efforts have been beneficial for our taxpayers, KEHP, and represent a model for other states to consider implementing."

A link to the full Interim Joint Committee meeting on Health Services can be found here.

Additional information on HDS's payment integrity solution, Claim Scan, can be found on their website at hds-rx.com.

About the Kentucky Employees' Health Plan (KEHP)

KEHP provides commercial healthcare coverage for roughly 300,000 Kentucky employees and retirees in the Commonwealth's government agencies and local schools. The plan's pharmacy spend accounted for just shy of $400 million for the first half of 2023.

About HealthPlan Data Solutions

HealthPlan Data Solutions (HDS) is an industry leading pharmacy analytics company that specializes in providing pharmacy payment integrity solutions, campaign management, and pharmacy claims insights. HDS's technology platform, Spotlight, leverages over 250 proprietary claim scanning algorithms and AI, matched with clinical expertise to provide actionable pharmacy benefit intelligence.

Founded by a team of pharmacists and IT professionals, HDS helps its customers identify, fix, and continuously monitor prescription claims data to maximize the value of their pharmacy benefit plans.