About Rx Optimum Plan Design (ROPD)

ROPD is a best practice, innovative, and newly released prescription drug plan design specifically targeted for use by benefit administrators and managers of employee prescription drug plans. ROPD provides a “best value” prescription drug plan design using evidence-based decision making that has been tested by a national pharmacy benefit manager (PBM) and a major employer. Adoption of ROPD reduces an employer’s drug cost an average of 2-5% immediately upon implementation¹, creates ongoing cost containment, and yet maintains a quality drug plan for employees.

ROPD was developed by pharmacy and benefit experts using their 6 years of drug plan operation experience and pharmacy management programs. ROPD is based upon their experience and successes that were carefully selected and proven to reduce cost. The development of a carefully selected drug formulary and utilization management programs used by ROPD were developed using an evidence-based medicine decision process, cost impact modeling, and consideration of prescriber and member impact.

ROPD includes a comprehensive listing of prescription drug classes, medications, limitations, formulary design, copayment structures and multiple utilization management programs compiled into one source. An employer can then deliver to a PBM the ROPD design for use in administering the employer’s drug claim processing. The ROPD contains detailed instructions on system coding and specifications on recommended pharmacy administrative programs and utilization management. ROPD places the employer, not the PBM, in the driver’s seat of controlling their drug plan design, and in turn controlling the access, use, and medication cost. It requires the PBM to administer the ROPD drug benefit design and provides the maximum control and flexibility for the employer drug plan at onset and with future updates. The employer achieves its goal of immediate and sustained cost containment of the prescription drug benefit.

• ROPD creates optimum value and promotes appropriate evidence-based medication use, while limiting drug use and cost to only those medications that are appropriate for use, reducing waste, mitigating overuse and abuse, and reducing claim overcharges due to erroneous billing. An example of limiting use to appropriate medication involves reducing medication use for off-label prescribing as it is not supported by FDA guidelines and labeling of the medications.
• ROPD instructs the pharmacy in how the prescription drug claims should be processed, and alerts the pharmacist to alternatives to dispense lower cost preferred brands and generic medications.
• ROPD can be customized and offers the plan sponsor various options with certain drugs, programs and copayments.

ROPD will assist the following groups:

• Employers / Health and Drug Plan Sponsors
• Prescription Benefit Administrators / Managers
• Managed Care Organizations / Third Party Administrators / Self-insured Administrators
• Taft-Hartley Trust Plans

Sample of ROPD Change in Drug Class
We are pleased to provide you a clear example of how the ROPD works. Below you will find a review of the one of today’s top drug classes found in most employer prescription drug plans. PPI or proton pump inhibitors represent a top class in both volume of prescriptions and total cost by drug class and required the plan design to control for both utilization, preferred product selection and total cost. This example shows how the ROPD would typically address a drug class for recommended changes and how the coding would be developed for your use with your PBM. Click here to view an ROPD sample.

Back to top

¹Average cost reduction is based on multiple factors such as current utilization, pricing, limitations, edits and management programs. Savings may be more but are not guaranteed.