PHARMACY BENEFIT INTELLIGENCE®

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Clinical Technology
Intelligence

PBIRx Clinical Consulting Team: 
Evidence-based clinical expertise delivering responsible, member-centric savings

PBIRx’s dedicated division, CTIRx® – Clinical Technology Intelligence, ensures that you are always informed and equipped to make strategic pharmacy benefit decisions with the support of our Clinical Consulting Team of PharmDs. With timely reporting and recommendations, our customized solutions are designed to enhance plan performance, manage emerging trends, and provide invaluable guidance on formulary design and the effective management of your pharmacy benefit spend.

Professional Doctor with Prescription Medication at Workplace

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The PBIRx Clinical Consulting Team:

  • Reduces unnecessary pharmacy spend by identifying and eliminating waste
  • Aligns therapy utilization with evidence-based best practices
  • Ensures appropriate access to optimal drug therapy for members
  • Insulates clients from adverse drug cost and utilization trends
  • Mitigates future cost trends through proactive management
Pharmacist searching for something in a white cabinet

PBIRx Pharmacists are on the forefront of the ever-changing pharmacy benefit landscape with deep knowledge in:

  • GLP-1s
  • Diabetes
  • Specialty Drugs
  • Biosimilars
  • Gene & Cell Therapy
  • Fertility
  • Oncology
  • Dermatology

Each client partner is assigned a dedicated pharmacist, delivering high-touch clinical expertise and tailored guidance at every step.

PBIRx – Reporting Platform

Client claim utilization files and PBM invoices,
loaded to PBIRx’s proprietary reporting and clinical algorithm software platform,
empower our team of Clinical Pharmacy Consultants to make informed, strategic recommendations.

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    Pharmalucent

    Pharmalucent program runs daily against all client claims to identify clinical outliers in real time and defines clinical program opportunities to be implemented

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    Algorithm Drug Code (ADC®)

    Our proprietary Algorithm Drug Code (ADC®) programs contain over a hundred utilization management rules that save our clients’ money and address PBM strategy gaps

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    RxSurge Alert

    RxSurge Alert™ reviews 100% of AWP cost increases based on Medi-Span pricing updates. Any significant increases are discussed with clients and allows our clinical team to develop or alter formulary strategies

PBIRx Clinical Services

CTIRx – Delivering insights and savings opportunities

Our proactive and meticulous analysis of all clinical data safeguards our clients against inappropriate medication use, significantly curtailing fraud, waste, and abuse. We understand that navigating the complexities of pharmaceuticals can be challenging, which is why our dedicated clinical consulting team is here to support you every step of the way.

  • Custom Formulary Management

    PBIRx offers customized formulary management programs that utilize our proprietary clinical formulary & utilization management rules that can be implemented to compliment & enhance the PBM’s formulary performance.

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    24/7 PBIRx Pharmacist Support

    PBIRx’s team of Clinical Pharmacy Consultants monitors our clinical mailbox to address any questions or urgent member issues that may arise.

  • Clinical Monthly Reports

    Each month, your assigned Clinical Pharmacy Consultant reviews a series of drug & disease state utilization reports to ensure any concerning trends are addressed early on & develop mitigation strategies for client discussion & potential implementation.

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    Implementation Support

    Your assigned Clinical Pharmacy Consultant will be a part of the PBM (or point solution) implementation team to ensure that all discovery, program evaluation and onboarding documents are accurately populated and thorough testing is done to ensure a smooth program launch. After launch, we will also monitor claims actively to ensure the program is running smoothly & accurately.

  • Rx Program Surveillance

    Your PBIRx clinical team conducts book of business claim utilization reviews to identify areas of fraud, waste & abuse and identifies concerning utilization trends along with emerging cost savings opportunities.

  • Clinical Program Evaluation & Development

    Your PBIRx clinical team is constantly vetting new & innovative clinical industry-wide strategies to help optimize your member’s pharmacy experience while maximizing the value of your pharmacy dollars.

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    Rx Market Watch

    Your PBIRx clinical team reviews weekly new drugs to market, new generics/biosimilars, pharmaceutical clinical trial publications, significant price changes & drug recalls to ensure clients are always up to date on how those changes will impact pharmacy spend & strategy.

  • PBM Formulary Changes Oversight

    As your PBM makes changes to their formularies, your assigned PBIRx Clinical Pharmacy Consultant will evaluate the product/program changes, associated member impact and projected savings to ensure those changes align with your Rx strategy, reflect clinical evidence-based practices and are properly implemented to ensure your members have a seamless experience.

  • New Drugs to Market

    Each month, receive a newsletter to your inbox to keep you apprised of new drugs to market, expanded indications, and first-time generics. Along with indications and costs, PBIRx includes valuable insights and strategies to navigate these emerging medications.

Intelligent • Specialized • Experienced

Our experienced team of pharmacists implement innovative strategies to optimize clinical outcomes and reduce costs for our clients

At PBIRx, we pride ourselves on our unwavering commitment to delivering exceptional clinical consulting services that enhance the effectiveness and value of our clients’ prescription drug plans. Our experienced clinical consulting team of PharmDs collaborate closely with stakeholders to ensure a comprehensive approach tailored to your specific needs.

Pharmacist helping customer with prescription

Our PBIRx PharmDs help clients with enhanced certifications & specializations

  • Pharmacy benefit clinical consulting
  • Pharmacy benefit formulary & utilization management
  • Obesity – GLP1 management
  • Diabetes drug therapy
  • Gene & Cell Therapy – HMX | Harvard Medical School
  • Pharmacogenomics – American Society of Health-System Pharmacists (ASHP)
  • Oncology specialty pharmacy
  • Fertility drug therapy
  • 340b programs
  • Medicare Part D & EGWP
  • Medication Therapy Management (MTM)
  • Community pharmacy

PBIRx clinical thought leaders

PBIRx’s team of Clinical Pharmacy Consultants have expertise in all areas of pharmacy practice and we utilize our talent to address key market data and develop custom, tailored solutions to ensure that our clients are always ahead of the latest cost trends.

PBIRx Blog Corner

At PBIRx, we believe knowledge is power! Keep up with industry trends and best practices.

Read our latest PBIRx blogs here: PBIRx Blog Corner

Chemist Smiling While Serving Customer In Pharmacy

Clinical Case Studies

doctor looking at x-ray of lungs and writing diagnosis Metadata
Pills and capsules over one-hundred-dollar bills
Hands writing rx prescription
Audit And Fraud Investigation. Auditor Using Magnifying Glass
A woman prepares for a subcutaneous self-injection with a semaglutide pen 'diet drug' . The modern wonder weight loss drug and diabetes treatment highlights a personal healthcare routine at home.

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