A pharmacy benefit manager (PBM) processes and pays prescription claims, manages drug formularies, and provides access to pharmacy networks. The PBM designs a plan for organizations, adjudicates claims based on the plan, and provides a consolidated invoice. Additional services include clinical consulting, drug efficiency analysis, customer service, discounted drug costs, management reports, and clinical education. Choosing a PBM that specializes in hospice care offers flexibility, clinical expertise in palliative care, targeted education, and familiarity with hospice regulations. Outcome Resources is a PBM exclusively for hospices that provides all medications at one low rate, customized formularies and plans, access to multiple pharmacy types on one invoice

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