Connecticut Pharmacy Benefit Consulting Services

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

With recent news suggesting that the cost of both specialty and prescription drugs is continuing to rise, the need to control such costs is pressing now more than ever. Furthermore, as the cost of services increases, entities that offer benefits, and specifically pharmacy benefits, will need to ensure that their PBMs are acting according to the terms and agreements in their plans; otherwise, they might be losing out on critical rebates and discounts! PBM contract audit language only allows up to 12 or 18 months that you can audit with a 90 day notice. If you do not follow the guidelines in your PBM contract you will lose the opportunity to audit and potentially leave 5% - 20% of your pharmacy spend in added profit to the PBM.

If you offer pharmacy benefits to your employees or members, we highly recommend connecting with an expert consultant like us to have your plan analyzed. Here is what we will do as part of our pharmacy benefit consulting services:

• Evaluate your current pharmacy benefit plan, including its design and the costs that you are currently subjected to.
• Identify where rebates and discounts are not being offered when they are available.
• Recommend a new plan design that more accurately reflects the lowest prices for your desired healthcare outcomes.
• Develop a PBM RFP negotiation strategy.

As we go through and analyze your plan, we will always present you with an unbiased, objective financial analysis that shows sensitivity to both the member and the client. For more information on how we can help create optimal healthcare outcomes for you and your members while reducing overall healthcare costs, please click here.

Located in Milford, CT, PBIRx's goal is to help you get more control over your healthcare costs. With a team of actuaries, analysts, clinicians, compliance officers and more, PBIRx always focuses on the clients' best interest rather than the PBM to ensure that they are not paying anymore than they need to be for desired healthcare outcomes. For more information, please call (888) 797-2479 or email info@pbirx.com.

Why Audit Your Pharmacy Benefit Plan?

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

If you are spending millions of dollars on your pharmacy benefit WHY wouldn't you audit your claims for accuracy to the pharmacy contract discounts and guarantees? Do you think that all "manual" input of data into the PBM system is done without any errors? If so, you are very wrong.

        

Unfortunately, plans choose to audit when there is a slight problem and realize that they have lost the opportunity to audit claims for many years because of PBM contract language, which only allows an audit of the previous 12 to 18 months. At PBIRx, clients are educated and audit their PBM claims every year as they look forward to that recovery check. One of our clients was just sent a check for over $200,000.

As we have stated so many times before, pharmacy spend is at an all time high with a very robust pipeline of expensive new drugs - some cost over $500,000 per year. Many entities fall victim to claims that are either not outlined or are adjudicated at lower discounts because of creative language in the contract with their PBM, and therefore, lose out on heaps of savings and/or recoveries. Another problem is when the PBM does not appropriately manage your eligibility and you are paying claims for terminated members.

But there has to be a way to avoid paying out of pocket for wrongly inherited costs, right? The good news is, the answer to that question is yes! Here at PBIRx, using our proprietary AuditRx technology we have been very successful in auditing pharmacy benefit plans with significant plan recoveries. As part of our auditing service, we also perform 340B compliance audits for many hospitals nationwide to make sure that the pharmacy is HRSA compliant and is aware of optimizing revenues.

For more information about our auditing services, please visit us at www.pbirx.com or contact us at (888) 797-2479 today.

PBIRx Responds To The FDA's Drug Safety Warning

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

Immediately following the March 24, 2015 notification by the FDA of a possible lethal interaction between Harvoni, Sovaldi or Sovaldi/Olysio combination, medication treatments for Hepatitis C, with the antiarrhythmic drug amiodarone, PBIRx developed an emergency algorithm and ran it against their entire client database of pharmacy claims within two hours.    

The results were immediately forwarded to their clients preventing potential emergency costs to their client’s medical benefit and their client’s employees’ quality of life. Strategic options for various clients were developed for an immediate reach out to affected members, if any.

PBIRx's advancing technology and expertise allows them to be very responsive when drug interactions are announced by the FDA to develop algorithms and run them against all of their clients' pharmacy claims data no matter which PBM currently adjudicates their claims. For over one year, PBIRx has been working with software developers, clinicians and technology to develop cutting edge proprietary clinical algorithms poised to manage pharmacy costs and optimize health care costs and outcomes.

PBIRx is very excited to be able to roll out their new value added services adjunct to current PBIRx proprietary programs to clients in 2015 which will better manage both pharmacy and medical benefits costs.

PBIRx Service Overview

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

For over a decade, the team here at PBIRx has been assisting clients with the management of their pharmacy benefit plans to ensure that they are receiving desired healthcare outcomes at the lowest possible cost. Since pharmacy costs can represent 16% to 40% of of all healthcare costs today depending on demographics, and since the costs of drugs and services are ever changing, entities that provide pharmacy benefits must remain in tune with the changes to ensure that the pricing in their PBM contract is accurate and up to date; this is exactly where we come in!

When matched with our own proprietary algorithms and similar cutting edge technology, the expertise and knowledge of our diverse staff allows us to create cost saving solutions for our clients with regards to their pharmacy benefit plans. Although you may assume that your plan will be carried out following the terms within, the truth of the matter is that there are instances where either your PBM is not adjudicating claims according to your contract terms or you are not receiving the rebates and discounts that are more competitive from the start. The following is just a brief overview of the services we proudly offer to assist you in these areas:

• Pharmacy Benefit Consulting
• Pharmacy Benefit Auditing (Using Audit Rx)
• Pharmacy Benefit Actuarial Services
• Third Party 340B Compliance Audits
• First Fill Optimization
• Clinical Algorithms To Detect FWA and Gaps Of Care
• Rebate Aggregation

Within each of these services, we will carefully analyze your current plan and see where your PBM has drifted from the agreements stated in your contract. Should adjustments need to be made, we will recommend modifications and new plan designs using the most up to date information about pricing as it relates to the healthcare services you currently receive. And the best part is, you will not have to sacrifice any of your desired healthcare outcomes to receive certain rebates and discounts; we will find you the savings you deserve all while maintaining the pharmaceutical drugs and services you are entitled to through your plan.

Have you yet to have your plan analyzed for potential discrepancies in terms of cost? If so, don't wait, connect with an expert like PBIRx today. To learn more about our services, please visit us on our website or give us a call at (888) 797-2479.