We foster a real PBM relationship, with savings as a result of high-quality, flexible care.
PharmPix doesn’t just look for discounts and rebates. We also look for ways to best manage utilization in order to foster a real PBM relationship with your company.
PBMs will often attempt savings-sharing models and base their saving assumptions on changes in the reimbursement, such as cost shifting, coordination of benefits, or the increase of generic alternatives entering the market place. A “Value Add” in pharmacy management is realized beyond the standard core components of an outsourced pharmacy department.
We also believe in controlling Fraud Waste and Abuse (FWA) and reducing inefficiencies in claim adjudication, which are the real values of a true PBM relationship. The following table shows you the difference:
|Plan sponsor’s claims reporting package||x|
|Payment validation according to the current plan design||x|
|Clinically-safe recommendation to decrease unnecessary utilization or replace current utilization with a more economic therapeutic exchange||x|
|Owns and executes an implementation plan to make sure our recommendation is a success||x|
|Aggressive FWA programs||x|
|System efficiencies that prevent unsafe and incorrect adjudication of claims||x|