PBM FAQ

How long does it take to get a detailed analysis completed?

After your complete claim file is received, a detailed analysis is produced within 10 business days.

What information is required to complete a PBM comparison?

All we need is your pricing claims file. A sample of the items can be found under our ‘Resources’ tab. Your broker, TPA or current PBM can provide this within 24 hours.

Why should I carve-out with RxPreferred?

Employers can get lost in the crowd at large PBMs. RxPreferred gives you the best of all worlds: the capabilities and competitive discounts of a best-in-class PBM coupled with our proprietary services and capabilities. With us, you have your own account management team, customer service, analysts, and billing support. Working with us, you gain the valuable expertise of pharmacy benefit specialists.

What does it mean to carve-out?

Historically, employers have trusted a health insurer to manage both medical and prescription benefits. Today, the trend for self-insured employers is to carve-out the pharmacy benefit and contract directly with a company like RxPreferred Benefits. This means the prescription benefit is separated from the medical benefit and managed by a different provider.

What are the benefits of being carved-out?

  • Real time ability to see exactly what we paid the pharmacy on your behalf. If you don’t have this access, you have no idea if you are being over charges.
  • Greater transparency in understanding the financial aspects of the pharmacy program.
  • More control over the plan, including the ability to customize a company’s unique needs.
  • Better cost management of traditional and specialty drugs. Historically, RxPreferred has lowered a client’s drug trend by 8%-15% compared to health plans. Factor in the compounding effect over time, and these savings become even more significant.
  • Watchdog over healthcare spend.
  • Better adherence to drug regiments due to clinical tools and the use of 90 day purchase options resulting in better healthcare outcomes.
  • Access to the best subject matter experts regarding all aspects of the pharmacy benefit including formulary, networks, utilization management, regulatory compliance and other clinical programs.
  • Ability to leverage innovative solutions pertaining to pharmacy benefits.