PRESCRIPTION BENEFITS: CHALLENGES & OBJECTIVES
Prescription Benefits Manager (PBM) contracts should Our self-insured clients have access to service providers rated #1 in customer satisfaction, while saving 11%-22% on prescription benefitsbe simple: provide the lowest price on prescriptions and provide accurate information so employers make good choices.
The fact is that PBM contracts are confusing to understand. Competitive Requests For Proposal and auditing often has not helped discover true costs because some of the code or definitions involving dispensing were not provided. Courts have forced new requirements on some PBMs to improve the fairness of information provided to the purchasing contractors. But that has left new questions to clarify.
We created a level playing field by dealing with transparent model PBM companies. They bargain for an administrative cost and the rest of the cost structure was made transparent. All data is provided, and the mystery of how much “spread” was pocketed was eliminated. EnvionRxOptions is our choice of providers.
PROGRAM FEATURES
- Management fees cover most services and contractually represents sole source of revenue;
- Complete pass-through of all manufacturer derived revenue;
- Complete pass-through of all pharmacy discounts (no spread on retail network, mail order, or specialty pharmacy);
- Absolute audit rights to the claim level including complete access to manufacturer and pharmacy contracts;
- On demand, online web-based reporting to members and employers;
- Dual URAC accreditation for Benefits and Drug Therapy;
- Medicare Part D and Retiree Drug Subsidy and Employer Group Waiver Plans;
- Rebates applied at point of sale.
VALUE-ADDED
The PBM Institute survey of over 500 consultants and employer managers rated our vendor, EnvisionRxOptions, #1 overall in 15 categories, including employee and employer satisfaction and savings as promised from 2007-2009. (Ratings not done in 2010)
NEXT STEPS
Call and schedule a discovery meeting. We will bring the experts and answer your questions. If you agree to an audit and a quote we will give you a clear idea of what your savings will be.
