Sixth Line of Defense
Reporting-based consultation
Our reports give you a simple, high-level view of what’s happening with your pharmacy benefit.
Our Consultation Support includes, but is not limited to, the following:
We start with our periodic KPI report that gives clients a high-level sense of what is going on with their pharmacy benefit and shows trending in:
- PMPM Plan Cost
- Drug Mix Indicators
- Pricing Indicators
- Utilization Indicators
- Cost Share Indicators
Based on where the opportunities reside with each clients’ pharmacy benefits plan, other, more specific reports are produced that will guide us on how to go about the opportunities detected. These other reports include, among many others:
- Top 100 Pharmacies
- Top 100 Medications
- Top 100 Physicians
Once we come up with these detailed, customized reports, we help our clients create the necessary strategy to approach these opportunities.
All are framed within aggressive Compliance and Quality Programs, and a service-level agreement that include, among other things:
- CMS Coverage Determination and Appeal Process
- PDE Management
- PDE-Claims Reconciliation Tool
- Transition Plan
- CMS 5-Stars Rating Program
- Performance Guarantees