Contain costs and engage members with PCM.

With PCM you can manage all value-added Rx and medical solutions in one place. Implement a program with our trusted partners or integrate your own programs. Our management platform is built to customize, fitting your needs.

Recommendations page header

Why contain costs and engage with PCM?

Managing third-party vendors is time-consuming for one plan, let alone your entire BOB. With PCM’s interactive platform, all program data is aggregated for faster, more efficient vendor management.

Support Solutions

  • PCM Rx Savings
  • Rx Cost Containment
  • Clinical Review
  • Medical Cash Payment

PCM Rx Savings

PCM Rx Savings is the original pharmacy savings program. By engaging physicians to switch participants from high-cost drugs to lower cost alternatives, PCM provides self-insured plan sponsors an average of 8-10% savings on total spend.

  • Proactive participant engagement
  • Validated PMPM savings
  • Full-suite program reporting
  • Dedicated Rx Engagement Team
3

The Rx Savings Process

PCM does the work. You see measurable, long-term cost containment for your plan or your client.

Recommendations Pharmacy Savings Savings Process 1

Identify low-cost Rx alternatives.

Our proprietary system analyzes claims and eligibility files to identify high-cost drugs and lower cost Rx alternatives.

Recommendations Pharmacy Savings Savings Process 2

Engage physicians.

PCM’s certified and licensed pharmacy team, contacts member’s doctors with cost-savings information. ​​

Recommendations Pharmacy Savings Savings Process 3

Gain member approval.

A member of our Rx Engagement Team reaches out to plan members for approval on proposed alternatives.

Recommendations Pharmacy Savings Savings Process 4

Facilitate Rx fill.

PCM pushes approved alternatives to the member’s pharmacy for quick, seamless fill that doesn’t interrupt the treatment plan.

Plan Sponsor Engagement 1

PCM Rx Engagement Team

Our team of in-house licensed pharmacists and certified pharmacy techs make navigating pharmacy care simple for plan members:

  • Proactive outreach on savings opportunities.
  • Personalized pharmacy education for members and providers.
  • Expert guidance for improved clinical outcomes.
  • Focus on lower out-of-pocket costs AND member health.

Validated Plan Savings

PCM Rx Savings is not like other cost containment programs. We provide line-by-line, drug-by-drug validated savings, so you can see where plan dollars are going. And the process is easy:

  • No plan changes required
  • Quick implementation
  • Limited HR workload
  • Minimal participant disruption
  • Lower patient copays
In Patient

See where your money is going with a complimentary analysis. 

Cost Containment

Engage members and providers to act on high-cost drugs. Our dedicated support team is here to do the heavy lifting, and our automated system is flexible enough to implement your vendors, a la carte.

  • Flexible Implementation
  • Comprehensive Reporting
  • Measurable PMPM Savings
  • Interactive Management Platform
  • Consolidated Claims​
3

Value-Added Cost Containment

Select the programs that fit your benefit strategy or integrate yourvendor in our system.

Recommendations Cost Containment Program Alt Funding

Alternate Funding

  • No plan changes
  • $0 participant co-pay
  • High case approval rates
  • Lower specialty spend
Recommendations Cost Containment Program International

International Rx

  • No medication changes
  • Direct shipping
  • Auto Rx identification
  • Minimal disruption
Recommendations Cost Containment Program Rx Tourism

Rx Tourism

  • 5-star facilities
  • Full-service concierge
  • Locked-in rates
  • Up to 70% savings

Simplified Solutions

PCM’s bolt-on cost containment solutions support brokers, consultants, TPAs, self-insured plans, and PBMs in building sustainable benefits packages that promote plan growth and participant engagement. ​​

With flexible implementation and comprehensive reporting, our team does the heavy lifting, you see the results.

Broker Grow Your Business

Build a plan-specific cost containment program with PCM.

 

Clinical Review

PCM’s clinical review solutions focus on balancing clinical outcomes and costs to prioritize member health. Specialty Review and Precision PGx support benefit experts in managing complex conditions with:

  • Patient-focused care
  • Reduced medical costs
  • Improved patient outcomes
  • Higher member engagement
3
Recommendations Clinical Review Program Specialty Review

Model-Based Care with Specialty Rx Review

Utilizing real-world evidence, Specialty Rx Review is a model-based care management solution that drives personalized specialty treatment. This, in turn, provides your participants with:

  • Individualized Care Planning: Specialty plans tailored to meet participant needs. 
  • Hassle-Free Implementation: Easy, anytime implementation with limited participant disruption. 

With Specialty Rx Review, plan can manage financial costs and improve health outcomes one person at a time.

Personalized Treatment with Precision PGx

Based on drug-gene interaction, Precision PGx identifies a participant’s metabolic rate which encourages doctors and patients to make informed decisions, resulting in reduced medical costs, improved participant health, and enhanced drug efficacy. 

The PGx process is simple. 

Recommendations Clinical Review The PGx Process 1
Recommendations Clinical Review The PGx Process 2
Recommendations Clinical REview The PGx Process 3 1

PCM identifies members who may benefit from PGx testing, then members receive a simple oral swab to complete at home.

Tests are processed and the results sent directly to the member using secure HIPAA guidelines.

Members can discuss results with a doctor via telemedicine or with their primary care provider.

Improve Health and Reduce Healthcare Costs

Our clinical engagement programs target the health and well-being of plan members, with additional administrative and reporting support from PCM’s clinical experts. 

  • Lower Health Care Costs: Manage and prevent chronic conditions, containing medical treatments and hospitalizations.
  • Improved Utilization: Encourage preventative services for more fewer hospitalizations and more favorable chronic treatment.
  • Health Data Insights: Collect and analyze health data, providing valuable, tailored insights to meet member needs.
  • Broker Collaboration: Add value by connecting self-insured plans with vendors, creating a more comprehensive package.
  • Attract and Retain: Use robust clinical program offerings to provide plan strategies that attract and retain customers.

 

Improve clinical outcomes and participant health with PCM.

Medical Payment

Claim review, data transparency, and cash-pay models provide measurable cost-savings while helping members choose smarter healthcare.

  • Medical Specialty Management
  • Payment Integrity
  • Cash Pay​​
3
Medical Specialty Management Screen
Drug rebates

Medical Specialty Management

With Medical Specialty Management, the plan gets visibility into​ how markups on medical pharmacy are affecting plan spend. 

  • Multi-vendor integration
  • Secure storage and transmission
  • Single point of access
  • Standardized semantics
  • Historical data storage

Payment Integrity

Review claims before and after payment to identify improperlybilled, processed, and paid claims, savings the plan and its members5-25% of their healthcare spend. With payment integrity plans can prevent and recover improper payments today.

  • Pre-payment review to ensure accuracy
  • Post-payment identifies overpayments
  • Asset recovery
  • Standardized semantics
  • Historical data storage
RFP Performance Errors 1
RFP Performance Errors 1

Cash Pay

A direct, transparent, immediate cash-pay model for plan sponsors. An efficient payment method.

  • Multi-vendor integration
  • Secure storage and transmission
  • Single point of access
  • Standardized semantics
  • Historical data storage

Take medical into account with PCM.

 

Contain costs and engage members with PCM.

With PCM you can manage all value-added Rx and medical solutions in one place. Implement a program with our trusted partners or integrate your own programs. Our management platform is built to customize, fitting your needs.

Recommendations page header

Why contain costs and engage with PCM?

Managing third-party vendors is time-consuming for one plan, let alone your entire BOB. With PCM’s interactive platform, all program data is aggregated for faster, more efficient vendor management.

Support Solutions

  • PCM Rx Savings
  • Rx Cost Containment
  • Clinical Review
  • Medical Cash Payment

PCM Rx Savings

PCM Rx Savings is the original pharmacy savings program. By engaging physicians to switch participants from high-cost drugs to lower cost alternatives, PCM provides self-insured plan sponsors an average of 8-10% savings on total spend.

  • Proactive participant engagement
  • Validated PMPM savings
  • Full-suite program reporting
  • Dedicated Rx Engagement Team

The Rx Savings Process

PCM does the work. You see measurable, long-term cost containment for your plan or your client.

Recommendations Pharmacy Savings Savings Process 1

Identify Low-Cost Alts

Our proprietary system analyzes claims and eligibility files to identify high-cost drugs and lower cost Rx alternatives.

Recommendations Pharmacy Savings Savings Process 2

Engage Physicians

PCM’s certified and licensed pharmacy team contacts member’s docturs with cost-savings information.

Recommendations Pharmacy Savings Savings Process 3

Gain Member Approval

A member of our Rx Engagement Team reaches out to plan members for approval on proposed alternatives.

Recommendations Pharmacy Savings Savings Process 4

Facilitate Rx Fill

PCM pushes approved alternatives to the member’s pharmacy for quick, seamless fill that doesn’t interrupt the treatment plan.

PCM Rx Engagement Team

Our team of in-house licensed pharmacists and certified pharmacy techs make navigating pharmacy care simple for plan members:

 

  • Proactive outreach on savings opportunities.
  • Personalized pharmacy education for members and providers.
  • Expert guidance for improved clinical outcomes.
  • Focus on lower out-of-pocket costs AND member health.

WHY PCM

Validated savings.

PCM Rx Savings is not like other cost containment programs. We provide line-by-live, drug-by-drug validated savings, so you can see where plan dollars are going. No plan changes required, quick implementation, and minimal disruption to HR or plan members.

Cost Containment

Our suite of cost containment solutions engage members and providers to act on high-cost drugs. Our dedicated support team is here to do the heavy lifting, and our automated system is flexible enough to implement your vendors, a la carte.

  • Turnkey implementation
  • Comprehensive reporting
  • Measurable PMPM savings
  • Interactive management platform
  • Consolidated claims

Value-Added Solutions

Select the programs that fit your benefit strategy or integrate yourvendor in our system.

Recommendations Cost Containment Program Alt Funding

Alternate Funding

Find alternative sources of funding for high-cost drugs.

 

  • No plan changes
  • $0 participant co-pay
  • High case approvals
  • Lower specialty spend
Recommendations Cost Containment Program International

International Rx

Reduce plan and participant spend on high-cost drugs with personal importation.

 

  • No medication changes
  • Direct shipping
  • Auto Rx identification
  • Minimal disruption
Recommendations Cost Containment Program Rx Tourism

Rx Tourism

An all-inclusive pharmacy tourism solution that sources safe, concierge pharmacy treatment

 

  • 5-star facilities
  • Full-service concierge
  • Lock-in rates
  • Up to 70% savings

WHY PCM

Simplified solutions.

PCM’s bolt-on cost containment solutions support brokers, consultants, TPAs, self-insured plans, and PBMs in building sustainable benefits packages that promote sustainability and engagement.

With flexible implementation and comprehensive reporting, out team does the heavy lifting, you see the results.

Clinical Review

PCM’s clinical review solutions focus on balancing clinical outcomes and costs to prioritize member health. Specialty Review and Precision PGx support benefit experts in managing complex conditions with:

  • Patient-focused care
  • Reduced medical costs
  • Improved patient outcomes
  • Higher member engagement

SPECIALTY RX REVIEW

Model-Based Care

Utilizing real-world evidence, Specialty Rx Review is a model-based care management solution that drives personalized specialty treatment. This, in turn, provides your participants with: 

Participant Engagement

Individualized Care Planning

Specialty plans tailored to meet participant needs.

Market Check Contract Comparison

Hassle-Free Implementation

Easy, anytime implementation with limited participant disruption.

With Specialty Rx Review, plan can manage financial costs and improve health outcomes one person at a time. 

PRESCISION PGX

Personalized Treatment

Based on drug-gene interaction, Precision PGx identifies a participant’s metabolic rate which encourages doctors and patients to make informed decisions, resulting in reduced medical costs, improved participant health, and enhanced drug efficacy. 

The PGx process is simple. 

Recommendations Clinical Review The PGx Process 1

PCM identifies members who may benefit from PGx testing, then members receive a simple oral swab to complete at home.

Recommendations Clinical Review The PGx Process 2

Tests are processed and the results sent directly to the member using secure HIPAA guidelines.

Recommendations Clinical REview The PGx Process 3 1

Members can discuss results with a doctor via telemedicine or with their primary care provider.

WHY PCM

Improve health. Reduce costs.

Our clinical engagement programs target the health and well-being of plan members, with additional administrative and reporting support from PCM’s clinical experts.

  • Improved utilization
  • Health data insights
  • Broker collaboration
  • Strategic management
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