Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
Just like we all set individual goals for ourselves when the first of every new year rolls around, it is important for businesses to do the same. As experts in the pharmacy benefit field, something we recommend is for business leaders to look deeper into their health care spend and see what total health care costs look like. And if, in fact, pharmacy benefit spend specifically is over budget, it is time to take more control. Below, take a look at how the PBIRx team can help with doing so.
Pharmacy Benefit Consulting
Through our pharmacy benefit consulting services, we will deliver our unbiased, objective financial analysis to you that considers both sensitivity to member and client impact after a comprehensive client needs analysis and discussion. Utilizing our knowledge of, and ability to anticipate change to the industry, we will provide you with our savings projections based on actual claim utilization, which is measured monthly and reported back to every client demonstrating our dedication to making accurate savings projections for clients.
Pharmacy Benefit Auditing
Our proprietary prescription claim audit program, AuditRx®, was designed to help your company get more control over the terms in your contract with your PBM. Through this service, we can help negotiate recoveries for times when there was a difference in claims billed versus your contract’s language. PBIRx AuditRx is used for commercial PBM auditing, 340B auditing and Medicare Part D auditing.
Third Party 340B Compliance Audits
Covered entities may lose their 340B status if they are not completely compliant with the program, which is why we can provide a compliance audit that helps determine any potential cause for concern. Completed on site, our reports will help prepare you for a true HRSA audit of this nature. References include clients who retained PBIRx for second audits after having successfully passed a HRSA audit after PBIRx compliance audit.
Clinical Technology Intelligence (CTIRx)
The goal of our CTIRx service is to promote clinically appropriate prescription drug utilization, that results in positive health care outcomes adjunct to pharmacy benefit savings. What we do here is run your claims through our CTIRx data processor, then analyze the findings to devise strategies that can lead to pharmacy savings. PBIRx staffs a large IT department including programmers and clinicians. As a result proprietary clinical algorithms are built and managed so that a Clinical Recommendation and Savings report can run within an hour of receiving actual client claims utilization.
Pharmacy Benefit Actuarial Services
This particular service comes in handy for those who offer pharmacy benefits to retired employees or employees who are eligible for Medicare. Since the government provides a 28% drug subsidy for qualified retiree plans, it is important for you to determine if you are eligible and if so, know how to proceed; through this service, our team will help you with all of that. Fee estimates are provided at no charge after initial review of data.
Considering that health care costs are still on the rise, we encourage you to start speaking with an expert like ourselves to make sure you are properly managing yours. To learn more about each of our services and how you can take advantage of them in 2016, please call (888) 797-2479 or fill out our online contact form.