Tuesday, August 11, 2015

The Benefits Of Working With PBIRx

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

As health care costs continue to rise, the need for a team who can help ensure that you are paying the right price for various services is extremely important now more than ever. Though you likely contract with a Pharmacy Benefit Manager that adjudicates pharmacy claims at a significant profit margin and a "Medical" broker/consultant, there is a significant cost savings opportunity in working with PBIRx, an independent Pharmacy Benefit Auditing and Consulting firm, that can assist in returning some of that profit back to your benefits budget. After 25 years, PBIRx is proud of our growth of successful clients, who use our intelligence in the form of proprietary clinical algorithms and technology along with a dedicated team of experienced professionals with longevity in the pharmacy benefit industry.  

But why is PBIRx the right partner to move your PBMs profits to your budget? 

To start, PBIRx's proprietary AuditRx program and experience in hours of negotiating pharmacy benefit recoveries with various PBMs at a senior level gives clients a unique edge in understanding how discounts, guarantees and other fees in a PBM Agreement change with language in fine print. This experience translates to starting with an optimal PBM Agreement giving clients an immediate 10%- 15% savings adjunct to implementation of proprietary clinical algorithms, which identify client specific clinical programs resulting in an additional 10% -15% savings.

Next, pharmacy claims data is reviewed monthly so that plan design and clinical savings opportunities can be identified on a continuum. A recent example is when the manufacturer of the drug Glumetza for diabetes increased the AWP by 500% in late June of 2015. For one client with one member, the cost for one prescription increased to $9,300 from $1,700. PBIRx immediately reached out so that the prescribing physician was made aware of the significant cost increase with alternative lower cost therapeutic alternatives saving the client what could have been a $100,000 cost increase for one member with one prescription. 

All plan design recommendations are provided with member disruption (if any) and estimated savings, which is measured and provided back to the client comparing PBIRx projected savings to actual savings. This is a huge benefit to our clients because it provides them with the opportunity to truly see how much money they have saved as a result of our ongoing analyses. PBIRx has several proven proprietary plan design savings that go well beyond optimal PBM contract discounts and clinical programs with an increase in member cost share as a very last option.

Furthermore, facilitation of implementation of all recommendations are provided by PBIRx experts that pay attention to the detail required including physician and member communication materials. PBIRx becomes a team member for all our clients specializing in all aspects of the pharmacy benefit from their in house pharmacy, if any, to 340B audit and compliance, PBM contract negotiation and management of all financial terms and reconciliation of guarantees, invoices and rebates. PBIRx experts are also face to face with members to present all aspects of the pharmacy benefit and to be available to answer any questions at all open enrollment meetings.

Last, but certainly not least, the PBIRx team of experts provides several ad hoc reports including allocation rates, disease/drug compliance metrics, cost increase or decrease based on various copay options, patient assistance program facilitation, and challenges when PBMs recommend programs that actually increase client costs under the guise of pharmacy benefit management "cost savings" recommendations. For our Accountable Care Organization clients projected metrics have always been within 1% of accuracy.

To learn more about our services, ask questions, or request a courtesy PBM contract review, please visit us on our website or dial (888) 797-2479 today.

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