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Pharmacy Benefits Consulting Services
Pharmacy Benefits Consulting is all we do. And no one in our industry does it better. It’s a bold promise we back up with unsurpassed PBM experience and a no-nonsense guarantee: If you don’t save money, we don’t get paid.
No other independent pharmacy benefits consulting firm offers the same level of proficiency across the pharmacy, PBM and health care industries as Innovative Rx Strategies. Our promise is to do the heavy lifting for employers, benefits brokers, third-party administrators (TPA), or health system or health plans by holding PBMs accountable to make sure our clients receive the greatest value possible from their pharmacy benefits investments.
We provide custom solutions that minimize disruption. And we make sure you’re getting the best pricing possible from PBMs while offering the best benefits programs possible to plan members.
Our pharmacy benefit consulting services include:
The pay-off: Clients receive the greatest value possible from their pharmacy benefits investments.
Innovative Plan Design and Clinical Consultation
Our team of consultants will help you create plan designs that drive member behavior. Pharmacists and clinical consultants will increase your knowledge of pharmacy market dynamics and trends — and how they impact your organization.
- Custom formularies
- Specialty drug management
- Maximization of generics
- Biosimilar strategies
- Rebate optimization
The pay-off: A PBM agreement with pricing terms and guarantees that are real and benefit your bottom line — not the PBM’s.
Cost-Saving PBM RFP Process Management
Our vendor-agnostic approach allows us to deliver pharmacy benefits solutions that match clients with the services they need — at the best pricing possible. We’ll navigate the ins-and-outs of pricing and contract complexities while protecting your interests at every turn.
- Assess contract and pricing terms
- Source PBMs when change is necessary
- Client-specific performance guarantees
- Negotiate and finalize PBM agreement
The pay-off: Your burden is lessened and the PBM is held accountable for providing the best service possible.
Pharmacy Benefit (PBM) Vendor Management
Our team of operational experts takes the burden of managing the pharmacy benefit off your shoulders. We will lead the day-to-day account management of your vendor relationship and hold the PBM accountable for operational excellence.
- Implementation leadership
- Pre and Post implementation audits
- Day to Day account management
- Vendor management
- Assistance with operational and member specific issues
- Operational leadership
- Clinical pharmacy leadership
The pay-off: We protect the health and safety of your members and proactively monitor and address the organization’s financial risk.
Pharmacy Claims Surveillance
Our team of experts continuously monitors your pharmacy benefit program performance and pharmacy claims. Leveraging data, analytics and expertise, our health actuary and financial and clinical analysts provide quarterly and an annual review of your prescription benefit program.
- High-cost claims analysis
- Quarterly reporting of trend and spend
- Quarterly surveillance of financial performance
- Annual financial guarantee reconciliation
The pay-off: We protect the health and safety of your members and proactively monitor and address the organization’s financial risk.
Medical Claims Surveillance
Our team of nurses and pharmacists manage risk by continuously reviewing the pharmacy claims that come through your medical plan. They identify opportunities to mitigate financial risk to the organization and improve the health of plan members – with little to no member disruption.
- Evaluate high-cost drug claims on medical plan
- Identify savings interventions and solutions
- Implement clinical and financial interventions
- Negotiate improved pricing
The pay-off: Our clients average at least 15% first-year savings — which could amount to 7-figure savings for many employers.
No-Risk Pharmacy Performance Assessment
Take control of your pharmacy benefit expenses by taking advantage of a no-cost, no-obligation savings assessment. With your current pharmacy benefit management contract, and a file containing your most recent 12 month of claims and rebates, our team can:
- Determine if the highest quality pharmacy benefits are being received at the lowest cost
- Identify shortcomings in your current PBM contract that are costing you money
- Complete a current PBM financial performance assessment
- Share strategies to capture identified savings