PBM Consulting and Management
As prescription drug programs undergo dramatic change and costs continue to rise, employers are taking a strategic approach to their programs. AEC Rx Solutions helps clients navigate the myriad of options to make the right decisions for their organizations.
AEC Rx Solutions ensures that plan sponsors retain the flexibility to design their program while leveraging all the benefits of proactive negotiations. We work to ensure that members have access to the most cost-effective prescription drug benefits plan. – John Adler
- PBM Program Evaluations
- We evaluate all new clinically or financially based programs that a PBM recommends.
- PBM Contract Negotiation
- Negotiate (or re-negotiate) plan sponsors’ PBM contract for critical definitions, terms, conditions, and savings.
- PBM RFP and Market Check Consulting
- Conduct a PBM RFP consulting review when the current PBM contract comes up for renewal. We negotiate a Market Check for the contract to refresh pricing after the second year of any initial or renegotiated contract.
- Non-contracted PBM Programs
- Evaluate new programs made available by other PBMs to determine whether they may be of value. If a program makes sense from a clinical, financial and member experience perspective, we approach the incumbent PBM to replicate and implement the program.
- Clinical and Pricing Audits
- Conduct annual audits for contract pricing compliance, dependent eligibility, Fraud, Waste and Abuse (FWA), Specialty Pharmacy Clinical PAs, Plan Design adjudication, and Formulary Co-pay adjudication.
- Vendor Program Review
- All vendors, including PBMs and stand-alone programs, may be referred to AEC Rx Solutions for evaluation and vetting to determine opportunity for financial savings; internal operational considerations; potential member disruption and implementation considerations.
- Client Communications
- Analyze new drug releases and create alerts that include financial modeling, and recommendation for coverage.
