Auditing PBM Agreements Can Save Money

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

“Pharmacy” benefit costs in the US are predicted to increase from $323 Billion in 2016 to $580-$610 Billion in 2021 according to a report by QuintilesIMS Holdings, Inc.    

Pharmacy Benefit Managers love when their clients do NOT audit their pharmacy benefit agreement!   This way the creative language in their contracts is not revealed and you pay more and more each month and each year.

Auditing pharmacy claims can generate significant monetary recoveries, while at the same time providing you with the confidence that your current pharmacy benefit financial discounts and guarantees are competitive for 2017.  PBIRx can tell you what parts of your PBM contract are not competitive. PBIRx clients experience a 5%–15% recovery of total drug spend, while at the same time ensuring that the PBM contract financial terms are being adjudicated correctly.

PBIRx®, a pharmacy benefit auditing and consulting corporation with locations in Connecticut and Missouri  since 1993, has the technology, tools, years of experience and experts that can help you recover lost dollars using our AuditRx® technology.   

PBIRx has several references nationwide that will attest to not only the audit recoveries that we facilitate, but also the savings to their pharmacy benefit budget.  Pharmacy Benefit Agreements, whether direct with the PBM, through the health plan carrier (i.e. Anthem, Cigna, Aetna, etc), or through a coalition, state that auditing may be limited to a certain time period (typically the previous 12 months).  Not knowing the period of time that you can audit your pharmacy benefit claims and not reaching out to PBIRx results in a lost recovery opportunity!

Why you should have PBIRx review your Pharmacy Benefit Agreement with no fee:

• To determine if there is a potential pharmacy benefit claims  recovery
• To know if the discounts in the PBM Agreement are actually being adjudicated as stated
• To learn if the financial model (discounts, rebates, guarantees, etc.) is 2017 competitive
• To provide union negotiated pharmacy benefits at a lower cost
• To know if there are other opportunities for savings to reduce costs while maintaining current copays and plan design features in negotiated union contracts
• To be reminded of important dates that could result in lost “time value of money”, i.e. guarantee/rebate remittance, agreement renewal period, non competitive automatic renewals, etc.

PBIRx will provide a courtesy review of your PBM agreement upon request.  Please contact David Sirowich at dsirowich@pbirx.com or call 203-882-1188 to discuss your potential savings in greater detail.  You can also visit our website www.pbirx.com for more information.

PBIRx has been exclusively providing intelligent solutions to clients in the management of pharmacy benefit costs since 1993. With a staff that includes IT personnel, actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers and many more experts, PBIRx’s mission is to create optimal health care outcomes while minimizing overall health care costs. For more information, please visit www.pbirx.com or call (888) 797-2479.

Charitable Donations

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

PBIRx is proud to share our latest initiative.  In appreciation of our partnership with new clients, PBIRx is donating to a charity to benefit the client’s community and/or youth programs so that our efforts ensure diversity.  PBIRx researches area organizations that include a higher percentage of funds directly to the charity needs and not the administration fees whenever possible.   

In 2016, PBIRx has made donations to the following charities on behalf of our clients:

• Nashoba Learning Group (enables kids/adults with autism to function throughout their lives - Bedford MA)
• Stand Up for Kids (benefits homeless and street kids - Worcester MA)
• The Next Step Fund (benefits teens & young adults impacted by cancer & blood diseases - Cambridge, MA)
•  St Jude's Children's Research Hospital
• Chicopee Boys & Girls Club, MA
• Ronald MacDonald House, Providence, RI
• Friends of Acadia (Conservation organization, Acadia, Maine)
• Girls Write Now (NY creative writing and mentoring NP organization - matches teenage girls with profession women writers)
• Big Brothers/Big Sisters of Greater Houston, Texas

PBIRx is excited to continue this initiative in 2017 and we look forward to the opportunity to make contributions to non-profit organizations in new communities.

PBIRx has been exclusively providing intelligent solutions to clients in the management of pharmacy benefit costs since 1993. With a staff that includes IT personnel, actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers and many more experts, PBIRx’s mission is to create optimal health care outcomes while minimizing overall health care costs. For more information, please visit www.pbirx.com or call (888) 797-2479.

Americans Continue To Struggle With Prescription Drug Costs

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

Once again prescription drug costs are making headlines as they continue to put a strain on our wallets. As reported recently by CNBC, approximately one third of Americans who rely on prescription medications are still struggling to keep up with price changes, and as a result, they're cutting back on their spending elsewhere. Though a $40.00 increase (on average) may not seem like much, it sure does add up quickly - especially for those who need more than one prescription.

In addition to cutting back on recreational activities or worse - cutting back on other things they need like groceries and food - CNBC explains that some patients are starting to view their prescriptions differently and "cut corners" with how they use them. And the result? Certainly a negative one on their health. In fact, the CNBC article details that Consumer Reports found that "24 percent of people who had seen higher drug prices in the past 12 months had skipped filling a prescription because of the cost."

Although health insurance changes have been made due to Obamacare, the out-of-pocket costs are what is doing it for patients. Brand-name, generic and specialty drugs have all seen a spike in price, and unfortunately, many of the common medications utilized are rising the most. "Medications that treat common conditions including asthma and high blood pressure were at the top of a list of drugs whose prices have risen in recent years," says CNBC. 

Since the need for prescription medication is certainly going to stick around, it is important for all providing entities to stay up to date with their pharmacy benefits to ensure that employees and members have the coverage they need to obtain what they need. If you're in charge of your entity's pharmacy benefits, give us a call at (888) 797-2479 or visit www.pbirx.com to learn how we can audit your plan for accuracy today!