Pharmacy Benefit Managers (PBMs)
Navigate the complexities of Medicare with confidence.
PBMs that simply recycle the same tools, processes, and resources used for their commercial business risk doing a lackluster job on behalf of their MA-PD or PDP clients – and running afoul of federal regulations.
Gorman Health Group assists PBMs execute those aspects of Medicare Part D where PBMs are typically most challenged: CMS compliance, operations, and Medicare Part D reimbursement and revenue management. We perform in depth compliance assessments to evaluate your PBM’s performance as a health plan delegated entity, and assist with preparing your PBM to receive URAC accreditation. And we can conduct a Part D Claims Repricing Audit to ensure that your PBM is accurately adjudicating claims on your client’s behalf and reporting this financial information accurately to CMS.
For PBMs needing additional support, our practice can provide staff training, implementation support, and pharmacy benefit practice support, including formulary management and the development of Medication Therapy Management programs.
