1. Objective PBM Overseer that Monitors Rx Claims before Paying PBM to Assure Adherence to Contract Terms and that Identifies Opportunities
HR Specialty Products & Services Catalogue Executive Summary
A No Frills Distillation of Vendor’s Marketing Collateral
Thomas A Ference
President & CEO
Human Resources Mining & Distribution Co
Locating, Validating and Accelerating HR  Innovation
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2. Objective PBM Overseer
The current marketplace for employee prescription drug benefits allows PBMs to set the rules for services and write extensive, confusing, vaguely-worded contracts so as to enable them to operate in an opaque environment.
Instead, this independent-of-any-PBM provider of services changes the paradigm via proprietary software that monitors claims in 11 critical areas using over 60 data elements
They provide a post-adjudication, prepayment analysis of pharmacy claims so that the typical 1% to 2% rate of material errors can be identified for correction prior to payments being made to the PBM.
Realized savings have been in the 15% to 30% range.

3. Objective PBM Overseer- Additional Services
Reporting of medication utilization and trends in each medication category
Comparing the PBM’s pricing for multisource medications to survey-based benchmark pricing
Objectively identifying opportunities for using Therapeutic Alternatives
Retrospectively auditing the PBM claims
Measuring, comparing and score-carding of submitted contract terms within the RFP using the plan sponsor’s own claims history
Consulting - RFP specifications, analyze responses, negotiate pricing /contract terms, finalize selection and contract, implementation, performance guarantee review

4. PBM Process Creates Opaqueness

5. Overseer Process Creates Transparency
Retrospective Claims Audit
Opportunities Identification
Pre-Payment Claims Monitoring
PBM RFP Submission Analysis
-Benchmark Pricing
-Therapeutic Alternatives
-Utilization / Trends
-Guaranteed Pricing Terms

6. Actual Savings Rates from Data and Consulting Services
Savings Realized
Components/Descriptions
Retrospective PBM Claims Audit
1-3%
Detailed audit of 2-3 yrs.
Opportunities Identification
5-10%
Formulary Management
Price Management
Prepayment Claims Monitoring
1-2%
Prepayment audit of charges
RFP Insight
8-10%
Score carding RFP submissions
Provider Insight
2-5%
Educational detailing of prescribers
Totals
17-30%

7. Next Steps
This product/service is contained in the HR Specialty Products & Services Catalogue™
Operational level details about this particular service provider can be obtained in conference with the vendor
The HR Mining &Distribution Co. is an independent and contracted representative of the vendor
Upon your request, we will arrange for an introduction that can range from a simple, quick conference call to a services overview / system demo
Tom Ference (Chicagoland area) or
Thank you for your potential interest in this fresh thinking