Services
Overview
Pharmacy Outcomes Specialists offers a variety of services for plan sponsors (employers, government agencies, union funds) and Medicare Part D sponsors through every phase of the pharmacy benefit program.
CLICK HERE TO SEE A POWER POINT OVERVIEW OF FIRM SERVICES.
CLICK ON EACH SERVICE AREA FOR MORE DETAILS.
For Plan Sponsors (Corporations, Unions, Mid Sized HMOs)
- Requests for Proposals (RFPs) for PBM services
- Contract Review and Analysis
- Renewal Analysis
- Carving Out Pharmacy from the Medical Plan
- Audits of Financial Terms
- Audits of Plan Design
- Audit of Rebate Payments
- Ongoing Monitoring of Financial and Service Performance
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For Plan Sponsors Contracting with Retail Pharmacies or Plans Needing Fraud, Waste and Abuse (FWA) Programs
- Report analysis of retail network and mail order aberrant behavior
- Desk audits to cost effectively determine and investigate errors
- On-site audits to investigate fraud, waste or abuse
- Investigations of provider, member and/or pharmacy collusion
- Waste by pharmacies in not dispensing low cost generic products
- Dashboard analytics of potential fraud, waste or abuse for plan sponsors
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For Medicare Part D Plan Sponsors
- Fraud, Waste and Abuse Programs
- Reporting to CMS
- Auditing of Pharmacies, Physicians, Members and PBMs
- Audit Medicare Part D Programs
- PDE reconciliation
- Medicare Part D Plan Design (TrOOP, LICS)
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Pharmacy Educational Services
For all Plan Sponsors wanting to discuss topical issues and market competitive information in the pharmacy benefits industry without PBM or Pharmaceutical Company “advertising”. Our annual Pharmacy Benefits Academy offers educational courses certified by HRCI through the Midwest Business Group on Health. |
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