Pharmacy Benefit Consulting
Established in 1993, PBIRx® has exclusively been providing intelligent solutions to our many clients in the management of pharmacy benefits. Our staff includes actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers and experts in the pharmacy benefit management industry. We serve as your personal pharmacy benefit specialist, helping you to evaluate, modify, design and execute solutions for your pharmacy benefit plan.
PBIRx® will present you with an unbiased, objective financial analysis always with sensitivity to member and client impact. Our proactive recommendations are based on our ability to anticipate change in the industry. The result is to reduce drug cost while optimizing healthcare outcomes. Our team is dedicated to these values.
There are many options available to clients today, which were not available until recently. Through our vast knowledge and expertise in pharmacy benefits, we save our clients a significant amount of money. Experience in recommending plan designs, ensuring smooth transitions, and analysis of data to more accurately manage drug trend is also an expertise provided by PBIRx®.
PBIRx® is the Expert in Rx Carve Out Plans
PBIRx® provides complete evaluation of present pharmacy benefits including plan design, traditional drugs, specialty drugs, current drug utilization and associated costs; development of PBM RFP, negotiation strategies; quotes from various vendors utilizing actual claims data for re-pricing; proprietary contract language relating to calculation methodologies for all financial terms/guarantees; implementation liaison; analysis of data and recommendations for optimum renewal rates and/or decreased pharmacy costs. Support to manage pharmacy costs and the pharmacy benefit manager include
- Initial and Ongoing Negotiation of Terms, Calculation Methodologies, Guarantees
- Audit all Financial Terms and Guarantees Annually
- Monitor Renewal Dates and Associated Opportunities Resulting in Improved Financial Models
- Monthly Pharmacy Data Review, Analysis, Recommendations and Report
- Identify New High Drug Usage for Optimal Discounts
- Recommendations and Associated Savings Using PBIRx® Proprietary Algorithms and Actual Drug Data
- Facilitator of Newly Implemented Programs
- Savings Measurement of Newly Implemented Programs
- JCode Carve Out
- Optimal Discounts for Limited Distribution Drugs
- Annual Audit & Recovery Using Proprietary PBIRx® Audit Program, AuditRx
- Eligibility Audit
- Quarterly Rebate Reconciliation
- Facilitate Recovery Discrepancy
- RDS Actuarial Attestation, Cost Reporting & Reconciliation (if required)
- Pharmaceutical Manufacturer Litigation Services
- Service Issue Facilitator
- Budgeting/Allocation Rates