SERVICES

Advocacy, expertise, and service for better pharmacy solutions.

The all-encompassing solution for pharmacy benefit management.

We'll manage every aspect of your client's pharmacy plans. Benefits include volume-purchasing discounts, a boutique service model with access to Member and Client Services (Customer Service), our in-house assistance center for members.

 

Insightful consulting at your service.

Let us consult on your pharmacy accounts. From PBM procurement to ongoing guidance, you’ll gain insights and strategies from industry-leading experts to keep you ahead of the benefit curve.

 

A flexible solution, tailored to each hospital’s unique needs.

RxBenefits’ Hospital Program provides best-in-class, consultative service tailored to each hospital’s unique needs, resulting in an aligned, hospital-centric relationship not found in the market today. The RxBenefits core model is uniquely positioned to support the distinct needs of the hospital market.

 

 

Gain the clarity and insight of
industry experts.

Focused Consulting Services

Even the most experienced pilot needs a co-pilot. Let RxBenefits guide you through the intricacies of PBM procurement and contract management. With our full-service assistance, your clients can save an average of 14% without a reduction in employee benefits. Plus, once the contract is in place, we actively monitor it to verify all performance guarantees.

PBM Procurement


For clients that need to contract directly with a PBM, we offer a full service approach that includes:

 
  • Defining scope and key decision criteria for the RFP process
  • Tailoring qualitative and quantitative questionnaires
  • Delivering a comprehensive proprietary RFP to leading PBMs
  • Evaluating all financial pricing models including transparent and traditional offers, as well as other more progressive options in the market, from Average Script Price (ASP) and formulary options to preferred networks
  • Analyzing RFP responses to identify finalists
 
  • Managing on-site presentation
  • Evaluating all PBMs qualitatively for overall comprehensive approach, capabilities and programs, including clinical, drug utilization, implementation service model, specialty, technology and member engagement
  • Producing a comprehensive report recommending the best PBM for each client’s unique needs
 

Ongoing PBM Oversight
and Management


We provide service for the life of the client contract with the PBM that includes:

 
  • Managing the contracting process
  • Oversee implementation meetings
  • Ensuring performance guarantees are met
  • Managing eligibility & claims exchange with third party vendors
  • Conducting clinical reviews
  • Providing plan design & co-pay modeling
  • Analyzing and assessing performance quarterly, based on guaranteed performance
  • Managing the PBM true-up of actual performance to contract guarantees
 
  • Comparing results to peers
  • Offering data support of claims, data warehousing and eligibility
  • Supplying a team of experts for pharmacy analytics and reporting
  • Hosting web-based client seminars
  • Comparing results to peers
  • Providing ongoing management to ensure PBM honors all commitments
  • Access to PBM senior leadership