Get Control Over Your Health Care Costs In 2016 With PBIRx

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

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.

PBIRx Presenting At 340B Coalition Annual Conference

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

From July 13 to July 15, members of the PBIRx team will be attending and presenting at the 340B Coalition Conference in Washington D.C. This conference is designed for covered entities, consultants, compliance experts and other individuals in the pharmaceutical field who work hand in hand with the 340B program on a regular basis. As a company that specializes in performing 340B compliance audits for our clients, we are extremely excited to have the opportunity to present and learn more about the future of 340B.

PBIRx is honored to be chosen to present "Independent HRSA 340B Compliance Auditing" during the Vendor Perspective Session on Tuesday, July 14th at 3:45 PM.

The agenda for this year's conference includes, but is not limited to:

• Stories from real life patients about their experience with the 340B program
• A discussion on the various ways that 340B savings can improve care for patients
• Tips on how to identify 340B compliance issues as well as how to solve them (this is especially important to our team as 340B compliance audits are one of the services we offer!)
• Updates from those at the legislative level on any program changes that may be taking effect
• Information on the rise of specialty drugs and limited distribution networks, including how this impacts covered entities

Here at PBIRx, our 340B compliance audits are completed on-site by a team of pharmacists, analysts and specialists in pharmacy benefits. We are available to provide detailed reports that prepare providing entities for actual HRSA audits, and will offer as much information as possible when it comes to any discrepancies in behavior that could cause one to lose their 340B status. 

Our ongoing services range from targeted claims review to full 340B committee member for covered entities.

For more information about our compliance audits, please visit www.pbirx.com or give us a call at (888) 797-2479.

340B Audits By PBIRx

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

As outlined by the U.S. Department of Health and Human Services, 340B Drug Pricing Programs require drug manufacturers to provide outpatient drugs at discounted prices to those organizations and entities that are entitled to them. In order to take advantage of this opportunity, such groups must be registered and enrolled in the program and must be compliant with all of the programs requirements. However, here at PBIRx, we understand that it can be easy to stray from program requirements and in turn, fail to be compliant with certain policies and procedures.

Our 340B Compliance Audits

Since failure to be compliant with the 340B Drug Pricing Program can cause a providing entity to lose their 340B status, we offer a third party 340B compliance audit service to ensure that your organization is operating based on the rules and regulations of the program. Performed on site, our audits can alert entities of any red flags that can trigger the loss of their 340B status. First, we will take a look at your policies, procedures and processes pertaining to 340B medications, then we will verify what you have in place to prevent non-qualified patients from receiving covered drugs and to prevent drugs from being subjected to duplicate discounts. Lastly, we will take a look at any transactions that directly relate to 340B medications and see where any discrepancies lie.

Although HRSA performs 340B compliance audits themselves, we at PBIRx can offer an in-depth report to help you ensure that your status remains as is. To learn more about our 340B audits as well as the rest of our pharmacy benefit auditing services, please visit us at www.pbirx.com or contact us at (888) 797-2479 today.