PBM Coordination
Navigate PBMs With Ease
Managing Pharmacy Benefit Managers can be complex and time-consuming. We help pharmacies streamline PBM communication, resolve claim issues, verify coverage requirements, and improve reimbursement coordination for smoother day-to-day operations.
PBM COORDINATION
Get Your Patients the Medications They Need.
We handle formulary exception requests, step therapy override documentation, peer-to-peer coordination with PBM medical directors, and formal appeals for adverse coverage decisions so patients access the medications their physicians prescribe.
When PBM coverage cannot be secured in time, we coordinate manufacturer patient assistance, copay assistance cards, and pharmacy discount programs to bridge the gap.
PROACTIVE FORMULARY MANAGEMENT
The Right Drug. Covered. Before the Prescription Is Written.
We verify prescribed medications against the patient’s specific PBM formulary tier, identify step therapy requirements, and flag any PA needs before the prescription is finalized, so problems are solved before the patient goes to the pharmacy.
When a preferred formulary alternative exists that is clinically equivalent, we flag it for physician consideration. When the prescribed drug is medically necessary, exception documentation is prepared immediately.
COVERAGE GAP MANAGEMENT
Medicare Gap. Navigated.
We calculate each Medicare patient’s projected Part D gap entry date, identify manufacturer copay assistance programs, verify Extra Help and Low Income Subsidy eligibility, and coordinate 90-day supply optimization all before the patient reaches the gap.
Patients actively managed through the coverage gap maintain an 89% medication adherence rate compared to 62% for unmanaged gap patients.
