Health Plan Clinical/Pharmacy Staff


Are you frustrated that PBMs are operating like a black box and making you shoot in the dark to control pharmacy and medical costs, and paying little to no attention to drug impacted avoidable medical costs?

Isn’t it the responsibility of your PBM?

✓  To help put together the best benefit design and formulary collaboratively by providing modeling capabilities using your historic pharmacy and medical claims data

✓  To provide optimal dosage to the patient at the optimal price

✓  To obtain maximum rebate income from the drug manufacturer

✓  To control all adverse drug events (ADEs)

✓  To conduct a physician driven and pharmacist assisted CMR on targeted population to improve their overall quality of life and substantially reduce avoidable medical and pharmacy costs

✓ To make sure over 90+% adherence is achieved

✓ To make sure that highest usage of generics is achieved. Based on claims data analysis from multiple plans, for example
» total brand scripts = 100 scripts
» total brand scripts where there is a generic substitute available = 17-20 scripts
» total brand scripts with DAW Flag = 5 Scripts (industry average)
» real opportunity to convert brand to generic = 12-15 scripts

✓ To seamlessly handle both non-specialty and specialty in a collaborative way
» eliminate duplicate payments under both Part-B and Part-D
» managing procurement of specialty drugs from preferred source can save up to $2-3M on $20M specialty drug spend
» substantial additional opportunities exist through Prior Authorization, Utilization, Case, and Concurrent Management

✓ To create a collaborative environment where health plan and PBM clinical/pharmacy staffs can work in tandem
✓ To work with you in a collaborative way to bring all the actionable information in real time

As a health plan clinician and/or pharmacist, you require all of the above services and information, because you control and monitor provider contractual obligations, own the patient relationship, and steward of the patient’s overall health outcomes. Your PBM must bring all actionable quality and cost information into your care/case/disease/utilization management workflow in real time. Such a revolutionary approach is delivered through Collaborative PBM Cloud™ and its IntelligentDUR360°Gateway™ which has never been offered by any other PBM due to their antiquated, fragmented, and legacy systems.

IntelligentDUR360°Gateway™ extracts from multiple components of Collaborative PBM Cloud™, analyzes, packages, and delivers actionable information into workflow of clinical/pharmacy staff of payer for collaborative decision making.

Comprehensive Service Offerings