Significant cost savings are achieved through a comprehensive approach to pharmacy benefits that begins with a review and renegotiation of the reimbursement contract followed by annual strategic initiatives that help defeat annual pharmacy trends.

PBM Contract Negotiation

Negotiate (or re-negotiate) plan sponsors’ PBM contract for critical definitions, terms, conditions, and savings.

Annual Strategic Plan

We work with the plan sponsor to create an individualized Annual Strategic Plan. The recommendations are prioritized and implemented with updates provided over the course of the plan year.

PBM Program Evaluations

We evaluate all new clinically or financially based programs that a PBM recommends.

Non-contracted PBM Programs

Evaluation of 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.

Annual 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.

Specialty Rx and Opioid Management Programs

Our clinical consultants evaluate numerous Specialty Drug and Opioid Management programs and recommend programs that best fit a plan’s specific utilization and member demographics.

High Cost Claims Clinical PA Oversight

Our clinical pharmacists review all claims over a specific amount to ensure that Clinical PA protocols were followed prior to approval. This protects the members’ health and the program costs.

Evaluation of Vendor Programs

All vendors, including PBMs and stand-alone programs, may be referred
to ELMCRx Solutions for evaluation and vetting to determine:

  • Opportunity for financial savings
  • Internal operational considerations
  • Potential member disruption
  • Implementation considerations

PBM RFP and Market Check Consulting

ELMCRx Solutions will 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.

Client Communications

Analyze new drug releases and create alerts that include financial modeling, and recommendation for coverage.

Member Communications

Complete review of any proposed pharmacy benefit management member communications
created by your staff or the PBM, for form, function, and technical accuracy.