For a complex medical issue, you’d call in a specialist. Our advice: Treat complex pharmacy plans the same way and call us. We’re pharmacy benefit specialists, offering complete, end-to-end solutions for pharmacy plan management. Point by point, we’ll implement a plan that outperforms previous contracts and exceeds every service expectation.The result: Happier employees and a healthier ROI for your client’s pharmacy plan.
New client relationships begin with an objective assessment of the existing pharmacy contract. Our methodology measures the contract’s performance against the market, reveals the plan’s actual adherence to contract terms and pricing and identifies weaknesses. Using these results, we develop a more beneficial course of action, as well as discover untapped opportunities to pursue in new plan designs and utilization management programs.
Our clients save an average of 10% on the initial re-price and analysis. Once the contract is in place, we monitor the market to ensure pricing terms remain competitive. Our contracts comprise a one year term, ensuring flexibility to renegotiate annually to reflect current market trends.
Small to mid-sized employers lack the negotiating clout to secure the best rates with PBMs, TPAs, and healthplans. Often, they can’t even get a contract that guarantees rates. RxBenefits leverages the aggregate membership of our entire client portfolio to secure volume discounts, ensuring competitive and auditable contracts negotiated to your client’s advantage.
Rather than standard pharmacy contracts that offer fixed terms for multiple years, RxBenefits contracts are renegotiated annually to ensure they are competitive and reflect current trends. Among the criteria we consider:
• Brand, generic, and specialty definitions
• Ingredient cost discounts by channel (90-day retail, mail, and specialty)
• Dispensing fees
• Administrative fees
• Formulary and drug coverage options
• Pharmacy network options
• Clinical program options
We provide a direct contract with pre-negotiated terms and conditions favorable to the client, fully transparent and auditable. By utilizing an addendum to the master PBM contract, we keep the process simple and convenient.
RxBenefits conducts random claim audits to ensure financial performance adheres to contractual terms. If discrepancies are found, we ensure our clients are “made whole.”
We excel in data analysis, delivering monthly, quarterly, and annual performance evaluations. Keeping a close eye on data reveals opportunities for plan design and clinical changes to reap additional savings.
A pre-determined review schedule allows us to report on plan performance, recommend potential revisions needed at renewal and present modeling of future changes.
From day one, a designated RxBenefits team services each client account. Trust us to monitor contract details, verify terms and ensure benefits are processed correctly. Our account team knows a client’s business inside and out, providing ongoing support and communication through detailed reviews and periodic meetings. Our team also acts as an extension of a client’s human resources department, able to assist with all activities related to pharmacy benefits.
Customer service is provided by RxAssure, an in-house customer service center staffed by RxBenefits associates in our Birmingham, Alabama, headquarters. Rather than the usual automated call system, members get prompt access to “live” knowledgeable customer service representatives. Focused on member satisfaction from start to finish, our team is ready to call a physician, pharmacy or others to resolve issues quickly and efficiently.
We operate a proprietary data system to integrate a client’s claims and eligibility files, ensuring superior accountability, data security, integrity and accessibility independent of the PBM. This technology gives us the ability to quickly analyze data and customize reports, with access to real-time numbers to address questions or concerns. It’s also user-friendly, enabling HR personnel to easily verify eligibility. Through our clearinghouse service, we can provide a client’s claim
files to third party vendors.
Implementing a new pharmacy plan can be time intensive for an employer. To ease the workload, RxBenefits manages the entire process. From providing ID cards and plan materials to conducting employee benefit presentations, we ensure a smooth and accurate transition to RxBenefits.