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?

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What Is A PBM? Hospice Pharmacy Services

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