OptimaRx Consulting Information

I offer following solutions for Pharmacy Benefits Management companies and Pharmacy chains. Generic Effective Rate Management: I work with PBMs to assess gaps in existing GER management process and then implement process improvement techniques and automated tools to ensure discounts are just within GER limits. Some of the tools used for GER management are as follows: - GER dashboard to track monthly and year-to-date performance - Automated pricing tool that suggests drug price changes based on factors such as profit/script for pharmacy, impact on members, cost of drugs, U&C limit and AWP discount - Tool to measure GER impact due to brand drugs going off-patent - Periodic GER performance reporting PBM-Pharmacy Contracting: The financial models I develop can be used by contract negotiators to instantaneously calculate the financial impact of changes in discounts, dispense fees and network fees. The models also provide information such as utilization across states, utilization across pharmacies and pharmacy footprint. Contract negotiators will be trained on the use of these models to negotiate favourable financial terms and contract limited networks. Network Performance Monitoring: The network performance dashboard will help PBMs monitor discounts and fees by line of business, drug type, price source, pharmacy chain and state. It helps track unusual shift in financial parameters, ensure claims are adjudicated at right rates and facilitate comparison of rates across network.