To manage the financial terms in a PBM contract PBIRx can provide a retrospective pharmacy claims audit as well as an ongoing audit of the pharmacy claims.  Our audit program, AuditRx, is an internal program developed by PBIRx.  This is not outsourced nor is it a PBM who is doing the audit on our behalf.  PBIRx leases the Medi-Span database as the source of AWP's.  PBIRx can provide both fee based or contingency based audit proposals.  PBIRx has been successful in negotiating significant recoveries for our clients. 

The PBIRx audit program will give the group "control" over their Pharmacy Benefit Manager.  The data also provides a "predictable" financial and plan design-modeling tool based on the specific drugs that are being dispensed for the group members.

PBIRx Retiree Drug Subsidy Services

PBIRx has the required actuaries and analysts to perform the actuarial attestation in addition to application support and cost reporting for the federal Retiree Drug Subsidy Program. 

Upon completion of an underwriting form, PBIRx will provide an initial plan design review at no charge with estimated subsidy recovery and estimated costs involved.   PBIRx can handle the entire application process for clients, including completion of entire application, manage eligibility changes, prepare cost reports & assist with reconciliation. 

PBIRx Consultative Services

Pharmacy Benefit Manager's (PBMs) are quite different from one another in many ways.  Some target certain market segments or client size with various types of infrastructure support.  Some have positioned their services and financial modeling to better serve smaller clients, unions, third party administrators, managed care organizations or medical carriers. 

PBIRx is dedicated to partnering with each individual client and optimize their present pharmacy benefit program and developing a project plan to achieve this goal.