What We Do

Custom Rx Solutions. Minimal Disruption.

You shouldn’t have to understand the in’s and out’s of such a complicated industry. We do. And we break down the PBM industry’s complexities to drive down costs.

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, practical experience as pharmacists 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 — we are pharmacist-led and our consultants are pharmacists. Our promise is to do the heavy lifting for employers, benefits brokers, third-party administrators (TPA),  health systems and health plans by holding PBMs accountable so that our clients receive the greatest value possible from their pharmacy benefits programs.

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 possible to plan members.

Our pharmacy benefits consulting services include:

Pharmacy Benefits Plan Assessment

The pay-off: Our clients average at least 15% first-year savings — which could amount to 7-figure savings for many employers.

Pharmacy Benefits Plan Assessment

Take control of your pharmacy benefits expenses by taking advantage of a no-risk, no-obligation pharmacy benefits savings assessment. All we need is two pieces of information: your current PBM contract, and a file containing your most recent 12 month of claims and rebates. With this detail and without disrupting current vendor relationships, our team will:

  • 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
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Innovative Plan Design and Clinical Consultation

The pay-off: Clients receive the greatest value possible from their pharmacy benefits programs.

Innovative Plan Design and Clinical Consultation

Our team designs plans that drive member behavior — as well as cost efficiencies. 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
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Cost-Saving PBM RFP Process Management

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
Pharmacy Benefit (PBM) Vendor Management

The pay-off: Your burden is lessened and the PBM is held accountable for providing the the highest quality service possible.

Pharmacy Benefit (PBM) Vendor Management

Our team of operational experts takes the burden of managing the pharmacy benefit program 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
Pharmacy Claims Surveillance

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 regular reviews of your benefit program utlization.

  • High-cost claims analysis
  • Quarterly reporting of trend and spend
  • Quarterly surveillance of financial performance
  • Annual financial guarantee reconciliation
Medical Claims Surveillance

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