In the Brave New World of Medicare Part D, designing, implementing, and managing an effective prescription drug plan is of critical importance. Gorman Health Group’s pharmacy benefits consultants have extensive and broad-ranging experience in formulary management, pharmacy benefit design, specialty pharmacy, and the use and implementation of pharmacy benefit management tools, including computerized edits, drug interaction screenings, and prior authorization programs. In addition, our consultants have diverse backgrounds, including pharmacotherapy and have worked in various healthcare practice settings, including managed care plans, Pharmacy Benefit Managers (PBMs), long-term care pharmacies, and pharmaceutical companies. This broad range of experience and practice settings allows GHG consultants to collaborate to provide an integrated approach to pharmacy benefit design and management that makes the most sense for your organization.

For health plans that contract with a PBM to offer a Medicare Part D benefit, GHG’s team of experts can evaluate PBM operations and performance on behalf of plan sponsors. This is of critical importance, given that under MMA, health plans are required by CMS to implement compliance programs to ensure that their PBMs accurately administer and process prescription claims – or face possible sanctions and penalties. GHG’s team of pharmacy benefits experts can provide the support necessary to monitor and identify potential pharmacy claims processing discrepancies, then help plans implement specific audits, and negotiate re-pricing terms, if necessary, to ensure that all discounts and rebates have been properly accounted for and reported to CMS – as required by federal regulations.