PBM Selection

A New Approach to PBM Selection

Over the decades, due to a lack of an integrated, scalable, and advanced technology platforms, traditional PBMs have introduced a notion into the marketplace that converting to a new PBM causes member service disruption, is expensive, and is time consuming. This status quo helps legacy PBMs to maintain their incumbency. By leveraging an integrated technology platform built on a unified data model, RxAdvance aims to erase this notion from the marketplace.

Typically, traditional PBMs will respond to an RFP from a plan sponsor, provide financial and performance guarantees, negotiate for best and final offer, and implement PBM services over the course of six to eight months. This outdated, lengthy process leaves the plan sponsor uncertain about expected outcomes, service levels, and financial performance. RxAdvance believes that following this path fails to provide true partnership to a plan sponsor. RxAdvance’s approach to true partnership has revolutionized the PBM selection process. Even before an RFP is issued, RxAdvance will collect all the previous year’s data – eligibility, accumulators, formulary, benefit, and processed pharmacy, medical, and lab claims. RxAdvance will then stand up a fully functional instance for the plan sponsor at no cost, as if RxAdvance was plan sponsor’s PBM.

RxAdvance will also conduct thorough analysis and reprocess all claims and, through a web portal, provide cost and quality saving opportunities for the plan sponsor. These saving opportunities can be achieved through a combination of core and value-added services listed below:

  1. Adverse Drug Events Management
  2. Physician-led CMR for MTM
  3. Three-step Medication Adherence management (MAM)
  4. Coverage Gap Prediction & Prescription Planning (CGP3)
  5. Fraud, Waste & Abuse Management
  6. Star Rating Improvement
  7. Bundled Episode Pharmacy Risk Management
  8. PoC, PoS, & Member Alert Services (through the mobile cloud)
  9. System-Driven Compliance Management
  10. Global Pharmacy Risk Management
  11. Conversion of Specialty Management from ‘Buy & Bill’ to a ‘Value-Based & Outcome-Driven’ Model
  12. Generic Promotion at the Point of Care, Point of Sale, and through Proactive Member Engagement
  13. Migration of the Patient from High-Cost to Low-Cost Generics

Apart from above value added services, RxAdvance also administers comprehensive PBM services with 40% lower operating costs, also providing the option for both pass-through and traditional pricing. Due to RxAdvance’s operational efficiencies and the platform’s ability to process workstreams in parallel, RxAdvance is able to implement clients in less time than traditional PBMs, while also ensuring that members do not experience disruption of service.

Comprehensive Service Offerings