The Continuous Monitoring service covers monthly data capture and validation, reviewing 100-percent of benefit claims along with all billing consolidation, monthly or quarterly online reports, and in-person reports to your team members.
Validate you only pay for what your members use
Track the total number of prescriptions and their cost versus PBM invoices each billing period.
Validate all charges for invoiced fees and services.
Make sure your PBM is delivering all promised discounts and rebates
Validate discounts received by class (brand, generic, specialty) against contracted discount guarantees.
Identify shortfalls that need to be offset for discount shortages, incorrect administrative fees, etc.
Reconcile rebate reporting against rebate-eligible Rx counts annually.
Receive a snapshot of your plan’s cost trends and savings
Compare year to date versus previous year-to-date drug costs, fees (admin, advisory, clinical), and rebate payments.
Evaluate actual amounts and actual amounts adjusted for discount shortfalls.
Identify savings of the current contract against the previous agreement or market check upgrade.