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What Is A PBM? Hospice Pharmacy Services
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What Is A PBM? Hospice Pharmacy Services


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What is a Pharmacy Benefit Manager? Why should my hospice partner with a PBM?

What is a Pharmacy Benefit Manager? Why should my hospice partner with a PBM?

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  • 1.
  • 2. WHAT IS A PBM
    (Pharmacy Benefit Manager) ?
    • Processes and Pays Prescription Claims
    • 3. Adjudicates Claims Online in Real-Time
    • 4. Manages Formulary or Preferred Drug List
    • 5. Provides Access to Network Pharmacies & Mail-Order
    • 6. Provides Clinical Management including Consultative Rx Expertise and Performance Reporting
  • 7. How Does A PBM Relationship Work?
    • Organization enters into Service Agreement with PBM
    • 8. PBM designs plan for Organization including Formulary, Prior Authorization Strategies, Parameters, Restrictions, and Benefit Coordination
    • 9. Organization utilizes Network Pharmacies & Mail-Order Pharmacy to fill prescriptions
    • 10. PBM Adjudicates Claims based on Organization’s Plan Design
    & Provides One Consolidated Invoice
  • 11. Other Services Provided By a PBM
    • Clinical Consulting
    PBM offers unbiased clinical information to Organization to assist them in making well informed, clinically and economically appropriate prescribing decisions
    • Drug Efficiency Analysis
    PBM evaluates Organization’s Drug Utilization and provides recommendations about opportunities to ensure not only cost-efficiencies but also best therapy and patient care
  • 12.
    • Customer Service
    PBM provides Account Managers & Website for 24/7 Access to Services
    • Reduced Drug Costs
    PBM provides volume discounted rate for medications
    • Management Reports
    PBM provides reports that detail Organization’s key drug-usage data, like claim costs, drug totals by patient, and cost per patient per day
    • Clinical Education Services
    PBM provides access to Education Programs via on-site workshops, teleconference tutorials, Live Web-based sessions, and Pre-Recorded Topics
  • 13. Why Choose a PBM that partners
    Exclusively with Hospices?
    • Flexibility in formulary and plan design
    • 14. Clinical Expertise from palliative care experts familiar with hospice-specific diagnoses and therapies and access to cutting-edge hospice-specific information
    • 15. Targeted Education Programs designed for hospice staff
    • 16. Focused and dedicated to the end-of-life care community
    • 17. Familiar with Hospice Industry regulations, standards, and practices
  • Why Choose Outcome Resources as your Hospice’s PBM?
    • A PBM Exclusively for Hospices
    • 18. One Low Discounted Rate for all Medications
    • 19. Customized Formulary & Plan Design specifically for your Hospice
    • 20. Access to Local Pharmacies, Mail-Order, and SNF’s on One Invoice
    • 21. Monthly Drug Efficiency Analysis, Management Reports, and Clinical Summary Included
    • 22. Unlimited Consultations with a team of specially trained Pharmacists Included
    • 23. 24/7 Live Customer Service and a Dedicated Account Manager
  • Thank You!
    We look forward to discussing in greater detail how
    a partnership with a PBM can make a difference
    for your Hospice!
    Jim Joyner, PharmD, CGP
    Director of Clinical Operations
    866-877-2053 x106
    Autumn SpenceNational Director of
    Business Development
    866-877-2053 x102