Our Services
PBM Contract Audits
At CoreRx Solutions, we specialize in comprehensive Pharmacy Benefit Manager (PBM) Contract Audits to ensure that your organization is getting the most value from your agreements. Our expert team meticulously reviews contract terms, pricing structures, and performance metrics to identify discrepancies, hidden fees, or areas of underperformance. By uncovering potential savings and ensuring transparency, we empower you to optimize your pharmacy benefit plans and protect your bottom line. Trust us to provide actionable insights and recommendations that align with your financial and operational goals.
Cost Containment Strategies
Managing healthcare costs is a critical challenge, and CoreRx Solutions is here to help with innovative Cost Containment Strategies. We analyze your current benefit plans and utilization patterns to develop customized solutions that reduce expenses without compromising quality of care. From formulary optimization to strategic negotiations, our approach focuses on sustainable savings. Our goal is to balance cost efficiency with employee satisfaction, ensuring your organization thrives in a competitive landscape while maintaining robust benefits.
Performance Monitoring
With CoreRx Solutions, you gain a partner dedicated to continuous improvement through Performance Monitoring. We implement advanced analytics and reporting tools to track the effectiveness of your pharmacy benefit programs in real-time. By evaluating key performance indicators such as cost trends, adherence rates, and plan utilization, we identify opportunities for enhancement and address potential issues before they escalate. Our detailed reports and proactive guidance ensure that your benefits strategy remains aligned with your organization’s objectives, delivering measurable results.
Employee Education
Empowering your workforce with knowledge is at the heart of our Employee Education services at CoreRx Solutions. We design and deliver tailored educational programs to help your employees understand their pharmacy benefits, make informed healthcare decisions, and maximize the value of their plans. Through workshops, digital resources, and one-on-one support, we simplify complex topics like formulary options, cost-sharing, and generic drug alternatives. By fostering a well-informed employee base, we help reduce confusion, improve satisfaction, and drive better health outcomes.
Compliance Support
Navigating the ever-changing landscape of healthcare regulations can be daunting, but CoreRx Solutions offers expert Compliance Support to keep your organization on track. We stay abreast of federal and state laws, as well as industry standards, to ensure your pharmacy benefit programs adhere to all relevant requirements. Our team provides guidance on audits, reporting obligations, and policy updates, minimizing the risk of penalties or legal challenges. With our support, you can focus on your core operations while we safeguard your compliance with confidence and precision.
Pharmacy Benefits Consulting
Pharmacy Plan Design
We collaborate with clients to develop and evaluate effective pharmacy benefit plan models at CoreRx Solutions. Our designs prioritize flexibility and affordability for both plan sponsors and members, creating robust plans that meet diverse needs while maintaining cost efficiency and quality of care.
PBM Vendor Request for Proposal (RFP):
At CoreRx Solutions, we guide you through the entire vendor selection process with expert support in RFP development. From identifying suitable PBM bidders to managing RFP fulfillment, evaluating proposals, and assisting with finalist selection, we ensure you partner with a vendor that aligns with your organization’s needs and goals.
PBM Contracting
CoreRx Solutions assists clients in crafting, negotiating, analyzing, and auditing PBM contracts. Leveraging our deep knowledge of evolving industry trends and current cost drivers in pharmacy benefits, we work to secure the most advantageous terms and pricing, ensuring your contracts deliver maximum value and transparency..
PBM Implementation Oversight
After selecting a PBM vendor, CoreRx Solutions provides dedicated oversight during the implementation phase. We ensure a seamless transition to the new PBM, minimizing disruption for members and addressing any challenges to keep your benefit program on track from day one.
PBM Audit Services
CoreRx Solutions offers comprehensive audit support to verify that your PBM adheres to contractual and financial commitments. Our audits cover pharmacy claims, rebates, retiree drug subsidies (RDS), prescription drug events (PDE), performance guarantees (PG), corporate compliance, and data validation, ensuring integrity and accountability in your PBM arrangements.
PBM Ongoing Support and Management:
Our consultants at CoreRx Solutions offer continuous support by working directly with your PBM to enhance economic control and prioritize quality of care and service for plan members. We promote transparency in financial, clinical, and operational processes while integrating medical guidelines, disease management, wellness, and other clinical programs to manage costs effectively. Our ongoing services include detailed reporting (monthly, quarterly, and ad-hoc), participation in PBM meetings and presentations, independent analysis of cost and utilization data, and regular market checks on pricing for specialty and traditional medications.