Actions| Pharmacy Benefit Strategies |
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| Product Manager | Laura Przysiecki |
| Product Demo | |
| Product Description |
Prescription drug expenses are one of the most complex areas of today’s healthcare arena. Costs are rising at alarming rates and make up a large part of benefit-plan expenses for employers. Pricing is constantly changing. And new generic and specialty medications are being introduced every day.
The good news is that the way you contract with your Pharmacy Benefit Manager (PBM) can play a key role in helping you gain control over those increasing costs — while still delivering competitive, quality benefits to employees. Key areas for managing your PBM include: • RFP Evaluation Finding the right PBM is the first step in streamlining your pharmacy benefits program. We provide the experience needed to understand PBM offerings, as well as industry dynamics and complexities. With a customized RFP process focused on your plan’s specific needs, we help you negotiate contract terms from a position of knowledge and strength. • Contract Negotiation We also offer our proprietary PBM contract, the most comprehensive in the industry. It offers optimal protection to you through full disclosure and transparency, financial control and protection, and critical plan termination rights. • Contract Compliance Audit To ensure compliance with our proprietary PBM contract, we validate actual claims discounts against contracted pricing terms on an annual basis. This ensures your PBM is meeting pricing and performance commitments, while eliminating discount tactics and interpretation. In addition, we also offer comprehensive pharmacy claims auditing services, including rebate validation and compliance with your benefit plan design. Our proprietary analysis technology analyzes 100 percent of claims, not a random sample, to ensure you have a complete picture of your PBM’s performance. |
| Marquee Clients | |
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| Client Feedback | |
| When I think about this product I love |
Good Features!
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| When I think about this product I wish they would improve |
Innovative product. needs no furthur improvement. |
| Claims Audit Solutions |
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| Product Manager | Laura Przysiecki |
| Product Demo | |
| Product Description |
The United States wastes $275 billion annually on healthcare spending through administrative inefficiencies, fraud, and abuse — that’s nearly $9,000 per second. Furthermore, forces outside of our control, such as “pay-or-play” provisions of the Patient Protection and Affordable Care Act and the “Cadillac tax,” have dictated that employers accelerate efforts toward reducing healthcare cost trends.
Yet employee health benefits remain one of the least-monitored corporate expenses. Most organizations rely on third-party administrators to manage the healthcare claims payment process, and claims auditing is often low on their long list of competing priorities — even though identifying errors can result in significant savings opportunities. Whether you’re implementing a new vendor or plan design, or conducting an annual review, Truven Health Analytics can help. Our claims auditing solutions help ensure claims are paid accurately — and in compliance with your plan design. Our team of experts, proven methodologies, and cutting-edge technology can be applied to: • Retrospective audits • Event-driven audits • Continuous monitoring • Fraud, waste, and abuse analytics |
| Marquee Clients | |
| Features |
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| Client Feedback | |
| When I think about this product I love | |
| When I think about this product I wish they would improve |
