Our Approach

Over the decades, due to lack of an integrated, scalable, and advanced technology platform traditional PBMs have successfully introduced a notion into the market place that converting to a new PBM causes member service disruption, is expensive, and is time consuming in order to maintain their incumbency. By leveraging an integrated technology platform built on a unified data model, RxAdvance’s Collaborative PBM cloud™ has erased this notion from the market place.

In a typical process, traditional PBMs will respond to an RFP from a plan sponsor, provide financial and performance guarantees, negotiate for best and final offer, and implement PBM services over the course of six to eight months. This outdated lengthy process leaves the plan sponsor uncertain about expected outcomes, service levels, and financial performance. RxAdvance believes this is not being a “true partner” to a plan sponsor.

RxAdvance’s approach to being “true partner” has revolutionized the PBM selection process. Even before an RFP is issued, RxAdvance will collect all the previous year’s data – eligibility, accumulators, formulary, benefit, and processed pharmacy, medical and lab claims. RxAdvance then stands up an “instance of PBM” for the plan sponsor at no cost, as if RxAdvance was plan sponsor’s PBM.

As part of standing up the instance, RxAdvance also conducts analysis and reprocess all claims and through a web portal provide cost and quality saving opportunity for the plan sponsors. These saving opportunities can be achieved through a combination of core and value-added services listed below:

  1. Adverse Drug Events Management Services
  2. Physician-led CMR for MTM Services
  3. 3 Step Medication Adherence management (MAM) Services
  4. Coverage gap prediction & prescription planning (CGP3) Services
  5. Fraud, Waste & Abuse Management Services
  6. Star Rating Improvement Services
  7. Bundled Episode Pharmacy Risk Management Services
  8. PoC, PoS, & Member Alert Services (MobileCloud)
  9. System-Driven Compliance Management Services
  10. Global Pharmacy Risk Management Services
  11. Converting Specialty from ‘Buy & Bill’ to ‘Authorize & Manage’ Model
  12. Promote untapped generic at point of care, point of sale, and proactive member engagement
  13. Migrate patient from high-cost to low cost generics

Apart from above value added services RxAdvance also administers comprehensive PBM services with 40% lower operating costs with an option for both pass-through and traditional pricing. RxAdvance implementation is between 8-10 weeks vs. 4-6 months of a traditional PBM. All through this process, RxAdvance like a true partner ensures that at no point the member experiences any disruption of service.