PBIRx Services

NEEDS ASSESSMENT:

PBIRx will provide a complete evaluation of present PBM contract, plan design and associated costs including savings analysis through a pharmacy carve out from the medical carrier.

RFP SERVICES:

PBIRx will customize an RFP specific to each individual clients needs and demographics.  The RFP includes a repricing analysis based on actual claims, formulary disruption and customized issues including specialty providers, disease management programs, high utilization review vendors.  PBIRx has no exclusive relationships for self funded pharmacy benefit services. 

FUNDING ARRANGEMENTS:

PBIRx has access to the following funding arrangements depending on the client needs; fully insured, capitated, shared savings, aggregate stop loss, self funded, generic only programs, discount card programs.

CONTRACT REVIEW:

PBIRx legal staff reviews all PBM contracts to be sure that negotiated points during the RFP process are included in contract.  PBIRx longevity in the industry allows us to negotiate the most optimal contract for our clients. 

IMPLEMENTATION:

PBIRx is involved in all client implementations to constantly review material and be sure deadlines are met to assure a seamless transition.  PBIRx is also involved in enrollment and informational meetings as requested.

CLAIMS ANALYSIS:

PBIRx provides a monthly claims review for each client.  This review is independent of the PBM reports and provides observations and recommendations based off client specific information.  Strategies are also provided to manage costs on a monthly basis.

AUDIT OF PHARMACY CLAIMS:

PBIRx leases the medispan database and has created a proprietary auditing program, AuditRx.  This is not outsourced nor is it the PBM who is providing this service.  Through the PBIRx negotiated contract we have been successful in recovering significant dollars for our clients.  This also assures the client that the PBIRx negotiated contract with the PBM is being adhered to. 

RETIREE DRUG SUBSIDY SERVICES:

PBIRx has the required actuaries and analysts to perform the actuarial attestation and application assistance for the Retiree Drug Subsidy program.  PBIRx also offers complete assistance in managing eligibility as well as cost reporting and reconciliation.

ADDITIONAL SERVICES:

PBIRx provides support to manage trend and the pharmacy benefit manager with a specific strategy for each individual client.  Additional services include:

• Benefit Modeling
• Rebate Reconciliation
• Eligibility Auditing
• Formulary Review
• Allocation Rates
• Specialty Pharmacy Evaluation