Our Approach

Over the decades, due to lack of an integrated, scalable, and advanced technology platform, traditional PBMs have made converting to a new PBM disruptive for members, expensive and time consuming to maintain their incumbency. RxAdvance’s Collaborative PBM cloud™ has erased this notion from the market place by leveraging an integrated technology platform built on a unified data model.

Typically, traditional PBMs will respond to an RFP from a plan sponsor, offer financial and performance guarantees, negotiate for best and final offer, and implement PBM services over the course of four to six 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 This outdated, lengthy process leaves the plan sponsor uncertain about expected outcomes, service levels, and financial performance.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 a plan sponsor issues an RFP, RxAdvance will collect all the previous year’s data – eligibility, accumulators, formulary, benefit, and processed pharmacy, medical and lab claims. We then stand up a “virtual PBM” for the plan sponsor at no cost, as if RxAdvance is the plan sponsor’s PBM.

As part of standing up the virtual PBM, RxAdvance reprocesses and analyzes all claims and provides cost and quality savings opportunities through a web portal. Making these saving opportunities possible is a combination of the following core and value-added services:

  1. Adverse Drug Events Management Services
  2. Physician-led CMR for MTM Services
  3. Three 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. Point of Care, Point of Sale, & Member Alert Services (MobileCloud)
  9. System-Driven Compliance Management Services
  10. Global Pharmacy Risk Management Services
  11. Specialty Conversion from ‘Buy & Bill’ to ‘Authorize & Manage’ Model
  12. Promotion of untapped generic opportunities at point of care, point of sale, and proactive member engagement
  13. Migration of patients from high-cost to low cost generics

In addition to these value added services, RxAdvance also administers comprehensive PBM services at 40% lower operating costs with an option for both pass-through and traditional pricing. RxAdvance implementation is between eight to ten weeks vs. the four to six months of a traditional PBM. Throughout this process, RxAdvance is a true partner, ensuring no member experiences a service disruption.