No-Risk. No Disruption.
The Innovative Rx Strategies contracting and clinical teams conduct a no-cost, no-obligation deep analysis of your PBM contract and plan performance to identify cost-saving opportunities. Our no-risk Rx savings assessment doesn’t disrupt your current PBM relationship, carrier or plan members and requires very little of your time.
Typical annual savings identified in our assessments range from 15% to 30% of total prescription drug costs.
Transparent and Unbiased
As independent pharmacy management consultants, we are transparent, presenting unbiased assessment findings.
What We Analyze
Our contracting and clinical teams scrutinize your Rx benefit program’s clinical, contractual and financial components and medical specialty claims to identify savings opportunities.
- PBM Contract and Amendments We thoroughly analyze your contract language to identify gaps and weaknesses that reduce its effectiveness and allow the PBM to underdeliver on their commitments. This examination includes:
- Definitions: Exclusion and missing critical terms
- Administration Fees: Post-termination and undefined services
- Financial Oversight: Market check and annual reconciliation
- Rebates: Market competitiveness and payment schedule
- One Year of Deidentified Rx Claims Our medical claims analysis reveals spending trends, inefficiencies and overpayments. By identifying the plan’s market competitiveness compared to others of similar size, we build the foundation for future cost-saving PBM negotiations.
- Rebate Receipts We review your plan’s rebate receipts to determine whether your PBM is delivering the value it promised or if savings are being left on the table. PBMs may promise complete rebate pass-through, but if there’s no transparency in the form of actual receipts, there’s no way to confirm that your plan is seeing those rebates.
Driving Results Through Actionable Strategies
Taking the insights from the no-risk Rx savings assessment, we recommend actionable strategies for either negotiating with your current PBM to improve pricing and contract terms or issuing an RFP using our proven, RFP management process. We also identify future cost-saving opportunities that result in a vastly improved pharmacy benefit plan that is cost-effective, clinically robust and tailored to the organization’s unique needs.
- Custom drug exclusions on the formulary
- Biosimilars
- Timeliness of rebates
- Prior authorization criteria
- Patient assistance programs
- Carve-out to specialty PBM
Begin Identifying Savings Now!
It’s simple to begin a no-risk Rx savings assessment. All we need is:
- Your current PBM contract
- A file containing the most recent 12 months of claims and rebates
We take it from there, helping you unlock significant savings and providing a roadmap for improving your pharmacy benefit plan.
