Analytics
Claims visibility, plan-specific insights, and comprehensive reporting reduce workload and improve margins.
Rebate Management
As advertised, drug rebates should provide savings on high-cost drugs, but they may be driving up costs, resulting in:
- An inflexible, closed formulary
- Opaque lowest net-cost metrics
- Inaccessible pricing details
- Automated prior-auth processes
- Limited cost-containment integrations
Create Client-Specific Formularies
Build a formulary based on lowest net-cost, not misaligned incentives.
Plan flexibility to control formulary changes, manage prior-auth protocols, and improve clinical outcomes.
Comprehensive reporting to indentify drug-level trends for easier deployment of lowest net-cost strategies.
Optimize Rebates
Analyze your existing claims data to identify plan rebates and highlight true net-cost at the drug level.
- Easy cost-containment integrations
- In-depth drug level reporting
- Improved clinical outcomes
Improve Plan Efficacy
Start optimizing rebates and managing plan costs with PCM.
Pharmacy Analytics
You don’t need more pharmacy claims data, you need better data intelligence. PCM provides cost-containment through deeper claims visibility, including:
- Eligibility Review
- Low-Value Drugs
- DAW Review
- Fraud, Waste, and Abuse
- Clinical Review
Claims-Level Plan Management
PCM’s web-based platform makes plan management simple.
Aggregate
View data across vendors and groups for a global plan view.
Analyze
Explore plan-specific insights to see where pharmacy dollars are going.
Act
Manage and validate optional and bolt-on programs.
Benefit Brokers
- Global data view
- Dynamic report builder
- Contract validation
- Rebate Management
Plan Sponsor
- Rebate Management
- Prior auth review
- Turnkey programs
- Actionable plan insights
TPAs
- BOB summary & detail view
- Automated file management
- Dynamic report builder
- Contract validation
Consultants
- Dynamic report builder
- Cost containment insights
- Contract performance review
- Easy drug search
If your claims could talk, what would they say?
Pharmacy benefit management, simplified. Click to learn more.
Medical Analytics
Aggregate diagnosis, procedure, provider, and participant data in the PCM platform for actionable medical insights.
- J Codes
- Chronic Care Conditions
- Percent of Medicare
- Facility Utilization
- Participant Spend
Transparent Claim Detail
With PCM’s Medical Analytics, plans can make data-driven decisions.
Validate PMPM Spend
Explore plan-specific insights to see where pharmacy dollars are going.
Analyze Medical Pharmacy
Review J Codes and aggregated spend for a global view.
Optimize Plan Design
Build a medical plan validated with claims-level detail.
If your claims could talk, what would they say?
PCM Medical Analytics drives global plan decisions. Click to learn more.
File Management
Track thousands of claims files, validating data integrity and managing dependencies.
- Aggregate vendor data
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Manage claims and eligibility files
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Securely transmit files
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Scale for group or BOB
Data Warehouse
Create a single source of truth for pharmacy and medical claims data.
- Multi-vendor integration
- Secure storage and transmission
- Single point of access
- Standardized semantics
- Historical data storage
File Autoloading
PCM’s secure infrastructure provides fully automated file:
Tracking
Tagging
Storage
Transmission
Efficient File Management
Click to learn how to track, tag, store, and transmit files efficiently.