Optimize Rx contract performance.

Complete dynamic contract performance audits and benchmark market PBM rates n half the time and at significantly less cost.

RFP Tools page header

Why audit with PCM?

Plan audits, RFPs, and annual reviews eat up time and resources. With PCM’s Rx benefit plan services you can automate contract evaluation, validation, and monitoring. 

Support Solutions

  • Rx Market Check
  • Rx Performance
  • Rebate Management

Rx Market Check

Driven by PCM’s interactive platform, Rx Market Check simplifies claims​ repricing and PBM contract comparison, dynamically benchmarking:

  • Cost share
  • Credits and fees
  • Rebates
  • Discounts
  • Exclusions
  • Trend
  • Guarantees
3

Evaluate Multiple PBMs With a Click

Rx Market Check provides visibility and the ability to dynamically change key contract metrics for invaluable insight into pre-built or custom contracts. 

Market Check Build Contracts

Custom Contracts

Build custom contracts to find the best fit for each client. Evaluate the impact of unique contract guarantees, cost share, trend, and other metrics. 

Market Check Contract Comparison

Standard Contracts

Utilize our 18 pre-built contracts from industry-leading vendors. Contract data is carefully vetted and updated to reflect current rates.

The Rx Market Check Process

PCM does the work. Our automated system and pharmacy experts allow you to easily compare validated contract rates without dedicating unnecessary time and resources to administrative work.

01

Automated Analysis

We load your data directly into our analytics system. And automated analysis aggregates and standardizes your data so your market check compares apples-to-apples. 

02

Dynamic Comparison

Using our interactive platform, you can compare current PBM rates to other market contracts. Our system allows you to dynamically adust fees, credits, effective discounts, rebates, and trend to see available savings with different contract structures.

03

Report Generation

Use our native report builder to download market check findings within minutes, including line-by-line and claim-by-claim detail and a PDF summary report. Standard and custom reports are available with a click. 

04

Expert Review

Review the market check findings with our pharmacy experts to ensure you find the contract that best fits the plan’s needs.

TPA Scalable Client Management

Data Transparency

As an independent third-party, PCM is committed to data visibility. Unlike other contract analysis vendors, we are not affiliated with any PBM or consultant and provide our partners with transparent, validated information, no strings attached. 

For questions about the data we use and how to integrate your data into our automated systems, contact us today. 

Contract Comparison for Support Your Strategies

Partner Home Broker

Benefit Brokers

Easily compare multiple market contracts to simplify renewal and RFP management.

Partners Page Plan Sponsor 1

Plan Sponsor

Ensure your contract aligns with market rates with a validated comparison.

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TPAs

Partner with brokers and consultants to simplify evaluation of self-funded contracts.

Partners Home Consultant 1

Consultants

Get a transparent look at plan, vendor, and contract data to better advise your clients.

Why PCM?

Use Case

Prescription Cost Management Best Practices: PBM Contract Market Check

Benefit consultants face significant challenges when managing pharmacy benefit spedn for clients. the lengthy process of evaluations PBM contracts for large employers often elaves limited time and resources for mid-market groups, resulting insuboptimal contract assessments due to resource constraints and complex PCM repricing.

This use case explores how one consultant utilized PCM technology to drastically reduce the time required for contract evaluation for a mid-market group from several weeks to a few busines hours.

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See how PCM simplifies Rx benefit management.

See how PCM simplifies Rx benefit management.

Rx Performance

Ensure contracted agreements are being met with an automatedRx Performance review, validating:

  • Guaranteed dispensing fees
  • Rebates
  • AWP discounts
  • Specialty drug categorization
  • Co-Pay tiers
3

Simplifying Rx Financial Audits

PCM’s Rx Performance tool compares actual claims data with PBM contract information to identify anomalies, errors, and unmet guarantees. Top to bottom analysis of the Rx Contract ensure the plan is receiving the best possible rates.

Market Check Build Contracts

Review Contract ​Guarantees

Compare contract guarantees to plan received discounts to negotiate better rates.

Analytics Med Ana Analyze medical pharmacy

AWP Mismatch

Evaluate mismatches between the provided and actual AWP to identify cost savings.

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Analytics Med Ana Optimize plan design

Rebate & Drug Exclusions

Pinpoint how overall plan spend is impacted by pricing and rebate exclusions.

Analytics Med Ana Validate PMPM Spend

Dipensing Fees

Identify claim level actual and contracted dispensing fee to ensure guarantees are met.​

Recommendations Cost Containment Program Alt Funding

Drug Rebates

Prioritize drug rebates that positively impact plan spend with claim-level rebate review.

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Drug rebates

Specialty Review

Confirm specialty drug categorization and impact on by utilization.

Contract Performance With a Click

Utilizing PCM’s automated system and proprietary algorithms, benefit experts are shortening audit times from weeks to hours.

01

Automated Analysis

We load plan data directly into our analytics system. An automated analysis aggregates and standardizes the numbers to validate the RX contract performance.

02

Dynamic Analytics

Key performance metrics are displayed in our interactive platform, giving you a claim-level view of your contract, validating contract guarantees. Native reports include claim level detail and summary charts for easy evaluation. ​

03

Expert Service

Our expert team evaluates performance results with you, ensuring data integrity and transparency. We provide plan recommendations based on years of audit experience so you can have complete information to make faster plan decisions.

Complete data transparency to drive global plan decisions.

Rebate Management

As advertised, drug rebates should provide savings on high-cost drugs, but they may be driving up costs, resulting in an inflexible formulary, opaque net-cost metrics, inaccessible pricing details, and limited cost-containment integrations. 

PCM supports benefit experts in identifying and implementing a low net-cost rebate management strategy.

3

Create Client-Specific Formularies

PCM supports you in building a formulary based on lowest net-cost, not misaligned incentives

Analytics Rebate Comprehensive Report

Comprehensive Reporting

Use our robust reporting tool to identify drug-level trends and employ lower net-cost strategies, including insights into savings programs, pricing, and exclusions.

Analytics Rebate Plan

Plan Flexibility

PCM’s proprietary program  supports you in controlling formulary changes, managing prior-auth protocols, and improving clinical outcomes.

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 efficiency and optimize rebates with PCM.

Optimize

Rx contract

performance.

Complete dynamic contract performance audits and benchmark market PBM rates in half the time and at significantly less cost.

RFP Tools page header

Why audit with PCM?

Plan audits, RFPs, and annual reviews eat up time and resources. With PCM’s Plan Insight and Management tools you can automate contract evaluation, validation, and monitoring. 

Support Solutions

  • Rx Market Check
  • Rx Performance
  • Rebate Management

Rx Market Check

Driven by PCM’s interactive platform, Rx Market Check simplifies claims​ repricing and PBM contract comparison by dynamically benchmarking:

  • Cost share
  • Credits and fees
  • Rebates
  • Discounts
  • Exclusions
  • Trend
  • Guarantees

Evaluate Multiple PBMs With a Click

Market Check Build Contracts

Standard Contracts

Utilize our 20+ pre-built contracts from industry-leading vendors. Contract data is carefully vetted and updated to reflect current rates.

Market Check Contract Comparison

Custom Contracts

Build custom contracts to find the best fit for each client. Evaluate the impact of unique contract guarantees, cost share, trend, and other metrics. 

WHY PCM

PCM does the work.

Our automated system and pharmacy experts allow you to easily compare validated contract rates without dedicating unnecessary time and resources to administration work.

  • Independent
  • Flexible
  • Agnostic
  • Responsive

Rx Performance

PCM’s Rx Performance simplifies financial audits by comparing actual claims data with PBM contract information to identify anomalies, errors, and unmet guarantees.

Top to bottom analysis of the Rx Contract ensure the plan is receiving the best possible rates.

Market Check Build Contracts

Review Contract Guarantees

Compare contract guarantees and received discounts to negotiate better rates. 

Analytics Med Ana Analyze medical pharmacy

AWP Mismatch

Evaluate mismatches between provided and actual AWP to identify cost savings.

Analytics Med Ana Optimize plan design

Rebate & Drug Exclusions

Pinpoint how overall plan spend is impacted by pricing and rebate exclusions.

Analytics Med Ana Validate PMPM Spend

Dispensing Fees

Identify claim level actual and contracted dispensing fees to ensure guarantees are met.

Recommendations Cost Containment Program Alt Funding

Drug Rebates

Prioritize drug rebates that positively impact plan spend with claim-level rebate review.

Recommendations Cost Containment Program Alt Funding

Specialty Review

Confirm specialty drug categorization and impact on by utilization.

WHY PCM

The Performance process is simple.

We load plan data directly into our analytics system, aggregating data to validate numbers. Built-in reporting provides claim-level and summary view of performance results. Our expert team walks with you through the analysis, arming you with complete plan information for faster decision making.

  • Automated analysis
  • Data visibility
  • Expert service

Rebate Management

Create client-centric formularies. 

PCM supports you in building a formulary based on lowest net-cost, not misaligned incentives. Analyze your existing claims data to identify plan rebates that benefit the plan and participants, not a third-party vendor. 

Analytics Rebate Plan

Plan Flexibility

PCM’s proprietary program supports you in controlling formulary changes, managing prior-auth protocols, and improving clinical outcomes.

Analytics Rebate Comprehensive Report

Comprehensive Reporting

Use our robust reporting tool to identify drug-level trends and employ lower net-cost strategies, including insights into savings programs, pricing, and exclusions.

WHY PCM

Optimized Rx Rebates

PCM simplifies rebate management, balancing clinical efficiency with cost containment.

  1. Plan carves out rebates from PBM contract.
  2. PCM assists plan in submitting rebates to aggregator.
  3. Rebates, combined with drug-level reporting, provided to plan.
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© 2023 by Prescription Care Management

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Fax 1-855-296-3933
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