Healthcare Solutions delivers a seamless, fully integrated and easy to use program that reduces pharmacy costs through aggressive pricing and clinical management programs.  Our clinical compliance protocols ensure appropriate dispensing of medically necessary prescription drugs through aggressive conversion to generics when appropriate; improved network participation based on contracts with major national pharmacy chains and independents; and, reporting capabilities for addressing program results and outcomes management. 

Finding the right pharmacy benefit manager (PBM) for auto accident claims means asking the right questions to be sure the company has the credentials to provide the best service and outcomes.  Consider the following questions when seeking a pharmacy partner:

• Competency – Does the PBM have expertise and experience managing auto accident cases or, is the bulk of the company’s business focused on group health or other lines of coverage? Is the PBM able to roll up multiple policyholders under one policy?  Does the PBM have a process for retrospective claims audits?

• Network Penetration – Does the PBM have a large nationwide network of pharmacies to make access easy and eliminate out-of-pocket expenses for policyholders? Does the PBM have auto-specific contracts? Does it have a mail order capability with aggressive outreach campaigns?

• Utilization – Does the PBM have a process to prevent use of inappropriate or non-covered medications?  What is the PBM’s methodology for rejecting pharmacy claims? Does the PBM have a generic dispensing rate that exceeds 70%? Can the PBM support state-specific mandates?

• Clinical Management – Does the PBM utilize a formulary to manage costs? Is it auto-specific?  Is it patient-level specific?  Is it reviewed and updated at least quarterly?
  

• Accountability – Does the PBM have advanced reporting systems providing information in a manner and format easily understood by the adjuster and the claims organization?
  

• Productivity – Is it easy for the adjuster or claims management team to access account information 24/7?  Does the PBM have knowledgeable service representatives on call around the clock to address questions and solve problems?

Click here to learn more more about Healthcare Solutions’ Pharmacy Benefit Management Programs.