Learn About The Pharmacy Benefit Manger Role

Americans pay more for prescription drugs than any country in the world, and the pharmaceutical industry earns billions in profits each year. Critics blame pharmacy benefit managers, or PBMs, for a portion of those high costs through their role as middlemen between insurance plans, drug makers and pharmacies.

How can Truveris help with pharmacy benefit management?

We actively provide personalized solutions to help make prescriptions more affordable, accessible, and transparent. But everyone in this industry says that. Here’s a breakdown of what that means, depending on where you are with your current PBM contract. Truveris helps manage everything from PBM requests for proposals to ongoing oversight of your pharmacy benefit to help ensure you actually get what you signed up for.

Considering a change in PBM?

Going out to bid can be very daunting and impacts your team’s day-to-day work (which often extends beyond benefits management). You don’t have time for that. Truveris helps package RFPs, and works with you to identify which PBMs to include in the bid process. (By the way, we aren’t limited to “the Big 3”.) We submit the RFP to the PBMs you choose. They upload their detail, including all contract terms and pricing for an easy side-by-side comparison of PBM offers. We highlight all contract exceptions for ease of follow-up rounds and best and final offers.

We also adjudicate your pharmacy claims to define how the PBM performs against your actual claim history – NOT something you will ever find in a spreadsheet. Antiquated spreadsheets focus on per-unit costs, which doesn’t tell you anything about total plan cost, estimated rebate yield, member disruption, network performance, etc... And how can you manage your pharmacy budget when you have no insight on what your total plan cost might be based on a new contract?

We provide all of those details for you for easy comparison of all PBMs. Then we assign a score based on all factors submitted by each PBM in the bid process, which helps automate results so you can focus on areas of interest for your plan based on your unique pain points. Those things that keep you up at night….

Thinking your PBM is performing per contract and as promised? Are you benefitting from all of your savings opportunities? Why not find out for sure?

Truveris can help brokers, health plans, and employers of all sizes manage pharmacy spend using our unique claims reprocessing technology to identify areas of non-performance for your plan. We have a deep understanding of PBM contracting, and their nuances and potential loopholes.

We apply our PBM expertise in understanding what the data is uncovering based on various formulary, rebate and utilization management techniques. We set up your contract terms, benefit design, etc., the same way your PBM does. We readjudicate your claims against the terms and rules set by your plan. Analyzing your claim data, we find plan-specific issues that may go otherwise unnoticed.

From these findings, we identify actions to take, such as plan design changes, correcting coding errors, contractual non-performance payouts, shortfalls for recovery, etc. (We call these INSIGHTS.) These ACTIONS typically RESULT in savings, increased rebates and recovered dollars by the PBM. We also work directly with employers and health plans that do not work with brokers or consultants. We bring the technology and expertise, and simply operate as an extension of your team. Your plan. Your way.

 Thinking of staying with your current PBM? You can still save money!

Truveris helps plans tighten up their PBM contracts by helping avoid typical PBM contracting loopholes while maximizing savings and rebate yield. We also provide analytics that identify opportunities for improvement against actual performance.

What is the average savings?

The average plan savings range from 12 to 28%. How can you say no to that?

 

Will you provide the savings that you say you will?

We take on risk associated with the performance because we are confident in our ability to help you save money you don’t need to spend. We know that pharmacy budget overages for self-insured employers can result in cutbacks in other areas you can’t afford. Our passion is to help minimize your risk.

We put our money where our mouth is. We offer a level of savings higher than our competition. This doesn’t even include the additional expertise that we bring to the table, giving our customers the confidence that they are making the right choice. We are confident in our abilities to achieve savings for your company and produce the results you need.

I already have a broker. How can Truveris help?

We work with brokers across the nation on the RFP bid process, plan oversight, correction and recovery. We also work directly with employers that do not work with brokers or consultants. We bring the PEOPLE, PROCESS, and PLATFORM to help ensure your plan is effectively priced and managed. We simply operate as an extension of your team – whatever that looks like for you.

I believe I have a good deal with my current PBM. How can Truveris help?

Truveris provides oversight throughout the term of your PBM contract, from initiating and managing the RFP process all the way through contract renewals and market checks. If it’s been two years or longer since you’ve checked on pricing, you will likely have a savings opportunity.

For instance, rebates and network discounts grow every year with drug price inflation. You may be able to increase rebate yield and benefit from better performing network discounts. We find that most PBM contracts have loopholes that prevent you from realizing new savings opportunities. The end of each contract period provides an opportunity to secure better contract rates with additional savings.

Additionally, we provide oversight through plan performance monitoring throughout the entire contract term. We deliver regular insights into how your plan is performing, along with actions to take to correct issues to help manage your pharmacy budget throughout the year. Our goal? To solve the problems that keep you up at night.

 

Why do employers look for help from Truveris?

There are a variety of reasons employers look for help, including:

Lack of trust in PBM

Increase in pharmacy spend/high cost of drugs

Upcoming contract renewal

Decision to terminate current contract and go out to RFP

Dissatisfaction with current PBM

New HR or benefits leader

New broker

New CFO

Business change – consolidation of vendors

 

When should I initiate the process?

We help clients manage their pharmacy benefit program throughout the PBM contract lifecycle, from RFP process focused on competitive bidding; to contract review, optimized before signature; and then to help ensure contract performance is met; to market checks and renewal. If you are considering submitting a PBM RFP, and there is at least 180 days before go-live, we’ll suggest TruBid. If there is a 90-day lead time before go-live, we’ll suggest TruBid Express. If you are in mid-contract, and unsure about your PBM’s performance, we can provide Oversight with TruGuard.

What makes Truveris different?

We believe that everyone in the pharmacy supply chain has the power to make a difference toward helping people live healthier lives with affordable, appropriate medication access. We start with our PEOPLE and the expertise they have amassed in the industry. Our focus on pharmacy benefits enables expert PROCESS management required to get the data, set up client-specific plan guidelines, reprocess and analyze 100% of claims to provide OVERSIGHT and INSIGHTS. Our scalable, purpose-built PLATFORM is built upon intimate knowledge of how the pharmacy supply chain is managed across stakeholders. With that expertise, we build and enhance our analytics to help identify areas in which clients can save on unnecessary spending or increase revenue where there is opportunity. Our PEOPLE, PROCESS, and PLATFORM provide automated assistance in getting things done so you can focus on other things knowing that we can help.

Will my data be secure?

Truveris offers the market’s only cloud-based, bid management and claim review platform recognized for its “SOC 2 security compliance,” the industry’s highest security standard for safeguarding protected health information.