TFG Monitors Rx Plans with CRM Service
Continuous claims monitoring from TFG will optimize your pharmacy plan — our auditors remind companies that negotiating the best PBM and PBM contract is only the beginning. Once things are underway, it’s crucial to make sure you are receiving the negotiated discounts. Contracts are complex and continually changing: Drug prices, new medications, reclassifications that can eliminate discounts, varying rebate levels, etc. It leaves many blind spots and loss of control unless you have a continuous monitoring system in place. We protect your plan and assure everything negotiated is genuinely delivered, on time, and all the time.
Our continuous Rx monitoring or CRM is a logical extension of an audit. We will collect claims data daily, weekly, or monthly throughout the year and, without any effort on your part, report our findingswith convenient on-line access to results for you. It includes:
- Invoice validation: You can immediately check if your bills are correct, and you are not paying for drug claims or fees that were never incurred by your members;
- Discount and Rebate Checks: See how your PBM is performing real-time against promised discount and rebate targets;
- Outlier Monitoring: Detect any new changes or surprises, such as new classifications, discount exceptions, overpriced medications, etc.;
- Hyperinflated Drug tracking: Medications that might be costly with low value, which in the case of High Deductible plans hurt members as well drive up plan cost in all scenarios.
In summary, CRM tracks and pro-actively monitors all your claims and costs. In a simple internet-accessible report, you’ll see your company’s trends and any red flags that require attention. Discrepancies can be reported back to the PBM and dealt with early on, so your members receive prescription plan benefits as planned, and the company gets the promised savings.
Continuous prescription plan monitoring helps your company avoid significant cash flow variations and ends the frustration and wasted time of year-end crunches and haggling over refunds. It reduces the need for extensive adjustments and reconciliation of your PBM account long after the close of the year. Also, as a bonus, since all data is available, TFG Partners can easily and quickly set-up any market-check or RFP, so you will continue to benefit from the most up to date and competitive pricing and contract terms.